Provider Demographics
NPI:1194048389
Name:SALISBURY, BRENT
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SALISBURY
Suffix:
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 1:108 WASHINGTON TOWNE BLVD N
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-1254
Mailing Address - Country:US
Mailing Address - Phone:814-734-3770
Mailing Address - Fax:814-734-9490
Practice Address - Street 1:108 WASHINGTON TOWNE BLVD N
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-1254
Practice Address - Country:US
Practice Address - Phone:814-734-3770
Practice Address - Fax:814-734-9490
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist