Provider Demographics
NPI:1619032976
Name:SALFITI CANTON PHARMACY INC
Entity Type:Organization
Organization Name:SALFITI CANTON PHARMACY INC
Other - Org Name:PEACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:I
Authorized Official - Last Name:SALFITI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-532-6112
Mailing Address - Street 1:300 S BUFFALO STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103
Mailing Address - Country:US
Mailing Address - Phone:903-567-4129
Mailing Address - Fax:903-567-6772
Practice Address - Street 1:300 S BUFFALO STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103
Practice Address - Country:US
Practice Address - Phone:903-567-4129
Practice Address - Fax:903-567-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
TX32122332B00000X, 3336C0003X
TX18273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4515396OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX140169Medicaid
4515396OtherNCPDP PROVIDER IDENTIFICATION NUMBER