Provider Demographics
NPI:1265192272
Name:CORDOVA-BARRETO, SALVADOR MANUEL (RPH)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:MANUEL
Last Name:CORDOVA-BARRETO
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 1:1726 MORNINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7022
Mailing Address - Country:US
Mailing Address - Phone:757-383-5664
Mailing Address - Fax:
Practice Address - Street 1:134 HARBISON BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2204
Practice Address - Country:US
Practice Address - Phone:803-407-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-19
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
SC43290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy