Provider Demographics
NPI:1396170841
Name:SALZWEDEL, DANIEL BRUCE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRUCE
Last Name:SALZWEDEL
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 MCDANIEL RD APT 1304
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8618
Mailing Address - Country:US
Mailing Address - Phone:920-319-1238
Mailing Address - Fax:
Practice Address - Street 1:3355 MCDANIEL RD APT 1304
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8618
Practice Address - Country:US
Practice Address - Phone:920-319-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17009-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist