Provider Demographics
NPI:1235448457
Name:SALEM, BRENT (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SALEM
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 1:1007 N PARKSIDE DR
Mailing Address - Street 2:#B408
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3114
Mailing Address - Country:US
Mailing Address - Phone:319-855-0098
Mailing Address - Fax:
Practice Address - Street 1:1925 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6149
Practice Address - Country:US
Practice Address - Phone:480-963-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist