Provider Demographics
NPI:1942392105
Name:SALEM, RIEAD S (RPH)
Entity Type:Individual
Prefix:MR
First Name:RIEAD
Middle Name:S
Last Name:SALEM
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 1:313 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5733
Mailing Address - Country:US
Mailing Address - Phone:734-487-8500
Mailing Address - Fax:
Practice Address - Street 1:313 ECORSE RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5733
Practice Address - Country:US
Practice Address - Phone:734-487-8500
Practice Address - Fax:734-487-8502
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2348212Medicaid