Provider Demographics
NPI:1790050656
Name:SALCEDO, KRISTIN DANIELLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:DANIELLE
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ZUREIQ PT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5070
Mailing Address - Country:US
Mailing Address - Phone:407-681-2110
Mailing Address - Fax:407-681-2118
Practice Address - Street 1:3333 UNIVERSITY BLVD
Practice Address - Street 2:BLVD
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7428
Practice Address - Country:US
Practice Address - Phone:407-681-2110
Practice Address - Fax:407-681-2118
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist