Healthcare Provider Details

I. General information

NPI: 1841154358
Provider Name (Legal Business Name): SOLISA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5624 MERRICK RD
MASSAPEQUA NY
11758-6217
US

IV. Provider business mailing address

5624 MERRICK RD
MASSAPEQUA NY
11758-6217
US

V. Phone/Fax

Practice location:
  • Phone: 516-960-5201
  • Fax:
Mailing address:
  • Phone: 516-960-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LILIAH DYAL-GUALBANCE
Title or Position: OWNER
Credential:
Phone: 516-960-5201