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General NPI Number Information
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NPI Number | 1518527381
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Entity Type | Organization
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Legal Business Name | SOLACE PHARMACY AND WELLNESS SHOP
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 1526 RIDGE AVE # CU
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2367
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Country | US
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Telephone | 267-764-1328
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Fax | 267-764-1330
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Provider Business Mailing Address
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Address Line | 1526 RIDGE AVE STE A
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City | PHILADELPHIA
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State | PA
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Zip | 19130-2367
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Country | US
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Telephone | 267-764-1328
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Fax | 267-764-1330
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Authorized Official
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Title or Position | OWNER
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Name | MARCUS PATTERSON
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Credential | PHARMD, MBA, MSPHARM
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Telephone | 267-764-1328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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