Provider Demographics
NPI:1730471343
Name:SALLAZ, RICHARD (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SALLAZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 BARRENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-9377
Mailing Address - Country:US
Mailing Address - Phone:540-974-5046
Mailing Address - Fax:
Practice Address - Street 1:101 ROSSER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3510
Practice Address - Country:US
Practice Address - Phone:540-942-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist