Provider Demographics
NPI:1952683955
Name:SALVADOR, JUSTINO (RPH)
Entity Type:Individual
Prefix:
First Name:JUSTINO
Middle Name:
Last Name:SALVADOR
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 1:1424 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0134
Mailing Address - Country:US
Mailing Address - Phone:707-441-1900
Mailing Address - Fax:707-441-0681
Practice Address - Street 1:1424 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0134
Practice Address - Country:US
Practice Address - Phone:707-441-1900
Practice Address - Fax:707-441-0681
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist