Provider Demographics
NPI:1700120607
Name:SALKE, BRANDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:SALKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 WEDGEWAY CT
Mailing Address - Street 2:
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1213
Mailing Address - Country:US
Mailing Address - Phone:888-287-2017
Mailing Address - Fax:
Practice Address - Street 1:4060 WEDGEWAY CT
Practice Address - Street 2:
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1213
Practice Address - Country:US
Practice Address - Phone:888-287-2017
Practice Address - Fax:888-287-2017
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist