Provider Demographics
NPI:1063188852
Name:SALAZAR, ANDREA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SALAZAR
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 1:7817 RANCHLAND DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-2145
Mailing Address - Country:US
Mailing Address - Phone:915-202-7517
Mailing Address - Fax:
Practice Address - Street 1:1100 GERONIMO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3402
Practice Address - Country:US
Practice Address - Phone:915-778-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist