MEDICARE: SOLARA MEDICAL SUPPLIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1114167111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLARA MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 VERMONT ST STE 115
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-2402
Country	:	US
Telephone Number	:	888-688-1455
Fax Number	:

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	03/03/2009
Last Update Date	:	10/14/2025

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