Provider Demographics
NPI:1619280815
Name:SALUD PHARMACY #1 LLC
Entity Type:Organization
Organization Name:SALUD PHARMACY #1 LLC
Other - Org Name:SALUD PHARMACY #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAECHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-476-6323
Mailing Address - Street 1:7310 CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-7495
Mailing Address - Country:US
Mailing Address - Phone:214-476-6323
Mailing Address - Fax:888-778-0421
Practice Address - Street 1:303 E CAMP WISDOM RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-2705
Practice Address - Country:US
Practice Address - Phone:972-283-0730
Practice Address - Fax:972-283-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27015OtherSTATE LICENSE