Provider Demographics
NPI:1528690468
Name:MIHALICK, SALEM (RPH)
Entity type:Individual
Prefix:
First Name:SALEM
Middle Name:
Last Name:MIHALICK
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 1:3195 AMES ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80214-8541
Mailing Address - Country:US
Mailing Address - Phone:303-902-2901
Mailing Address - Fax:
Practice Address - Street 1:3195 AMES ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80214-8541
Practice Address - Country:US
Practice Address - Phone:303-902-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist