Provider Demographics
NPI:1770890741
Name:SALTAFORMAGGIO, BERNARD (RPH)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:SALTAFORMAGGIO
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:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:WATSON
Mailing Address - State:LA
Mailing Address - Zip Code:70786-0710
Mailing Address - Country:US
Mailing Address - Phone:225-667-4286
Mailing Address - Fax:
Practice Address - Street 1:34876 LA HIGHWAY 1019
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-0659
Practice Address - Country:US
Practice Address - Phone:225-667-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA11448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist