Healthcare Provider Details

I. General information

NPI: 1164746228
Provider Name (Legal Business Name): SOLANTIC OF ORLANDO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S KIRKMAN RD
ORLANDO FL
32811-2346
US

IV. Provider business mailing address

8711 PERIMETER PARK BLVD SUITE 6
JACKSONVILLE FL
32216-6388
US

V. Phone/Fax

Practice location:
  • Phone: 407-362-2030
  • Fax: 407-362-2030
Mailing address:
  • Phone: 904-223-2330
  • Fax: 904-425-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberHCC 6375
License Number StateFL

VIII. Authorized Official

Name: KAREN BOWLING
Title or Position: CEO
Credential:
Phone: 904-223-2330