Provider Demographics
NPI:1487792321
Name:SALOME, WANDA (RPH)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:SALOME
Suffix:
Gender:F
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:C13 CALLE 1
Mailing Address - Street 2:ESTANCIAS DE SAN FERNANDO
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:C13 CALLE 1
Practice Address - Street 2:ESTANCIAS DE SAN FERNANDO
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5206
Practice Address - Country:US
Practice Address - Phone:787-768-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist