Provider Demographics
NPI:1255423166
Name:SALCIDO, AMISTA LONE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMISTA
Middle Name:LONE
Last Name:SALCIDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AMISTA
Other - Middle Name:ANNE
Other - Last Name:LONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:14800 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7210
Mailing Address - Country:US
Mailing Address - Phone:915-526-0073
Mailing Address - Fax:
Practice Address - Street 1:14800 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7210
Practice Address - Country:US
Practice Address - Phone:915-526-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX431111835P0018X
AZS11964183500000X
VA0202013036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist