Provider Demographics
NPI:1578800413
Name:SALAS, MARTIN STEVEN (RPH)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:STEVEN
Last Name:SALAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1946
Mailing Address - Country:US
Mailing Address - Phone:505-857-9783
Mailing Address - Fax:505-857-9835
Practice Address - Street 1:8100 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1946
Practice Address - Country:US
Practice Address - Phone:505-857-9783
Practice Address - Fax:505-857-9835
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist