Provider Demographics
NPI:1770022196
Name:SALEM, WALAA M
Entity Type:Individual
Prefix:
First Name:WALAA
Middle Name:M
Last Name:SALEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 VIA LORADO
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4464
Mailing Address - Country:US
Mailing Address - Phone:310-293-0238
Mailing Address - Fax:866-601-5352
Practice Address - Street 1:400 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6814
Practice Address - Country:US
Practice Address - Phone:310-937-4352
Practice Address - Fax:866-601-5352
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist