Provider Demographics
NPI:1235448457
Name:SALEM, BRENT (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:SALEM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 LASSEN WAY
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-5413
Mailing Address - Country:US
Mailing Address - Phone:319-855-0098
Mailing Address - Fax:
Practice Address - Street 1:133 15TH ST
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2746
Practice Address - Country:US
Practice Address - Phone:831-373-1225
Practice Address - Fax:831-373-3705
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90588183500000X
AZS017585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist