Provider Demographics
NPI:1437979184
Name:SALCEDO, LILLIAN AVERY (PHARMD)
Entity type:Individual
Prefix:
First Name:LILLIAN AVERY
Middle Name:
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3404
Mailing Address - Country:US
Mailing Address - Phone:540-776-8820
Mailing Address - Fax:540-767-6501
Practice Address - Street 1:4375 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3404
Practice Address - Country:US
Practice Address - Phone:540-776-8820
Practice Address - Fax:540-767-6501
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022223511835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist