Healthcare Provider Details

I. General information

NPI: 1366070062
Provider Name (Legal Business Name): SOLMI PARK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 03/29/2020
Certification Date: 03/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LINCOLN HWY
EDISON NJ
08820-3906
US

IV. Provider business mailing address

89 JEFFERSON AVE
CRESSKILL NJ
07626-2534
US

V. Phone/Fax

Practice location:
  • Phone: 833-423-7334
  • Fax:
Mailing address:
  • Phone: 201-414-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04078000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: