Basic Information
| Provider Information | |||||||||
| NPI: | 1619215035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALIM | ||||||||
| FirstName: | THEODORE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2770 W BAY DR | ||||||||
| Address2: | |||||||||
| City: | BELLEAIR BLUFFS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337702618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275860240 | ||||||||
| FaxNumber: | 7275860312 | ||||||||
| Practice Location | |||||||||
| Address1: | 2770 W BAY DR | ||||||||
| Address2: | |||||||||
| City: | BELLEAIR BLUFFS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337702618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275860240 | ||||||||
| FaxNumber: | 7275860312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2013 | ||||||||
| LastUpdateDate: | 01/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS23284 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.