Provider Demographics
NPI:1932817848
Name:SALAZAR, JOEL JR
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:SALAZAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N STUART BLVD
Mailing Address - Street 2:
Mailing Address - City:ELOY
Mailing Address - State:AZ
Mailing Address - Zip Code:85131-2507
Mailing Address - Country:US
Mailing Address - Phone:520-381-0355
Mailing Address - Fax:
Practice Address - Street 1:205 N STUART BLVD
Practice Address - Street 2:
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131-2507
Practice Address - Country:US
Practice Address - Phone:520-381-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist