Healthcare Provider Details

I. General information

NPI: 1093108805
Provider Name (Legal Business Name): SOLARIS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date: 01/19/2024
Reactivation Date: 02/23/2024

III. Provider practice location address

91 BARNETT SHALE
BRIDGEPORT TX
76426-2266
US

IV. Provider business mailing address

91 BARNETT SHALE
BRIDGEPORT TX
76426-2266
US

V. Phone/Fax

Practice location:
  • Phone: 940-208-1638
  • Fax: 940-233-1093
Mailing address:
  • Phone: 940-208-1638
  • Fax: 940-233-1093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number25715
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number25715
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSE HART
Title or Position: CFO/OFFICER
Credential:
Phone: 940-627-1011