=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851775688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLUS PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2015
-----------------------------------------------------
Last Update Date | 12/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 W ATLANTIC AVE
-----------------------------------------------------
City | LAUREL SPRINGS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08021-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-282-4410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 W ATLANTIC AVE
-----------------------------------------------------
City | LAUREL SPRINGS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08021-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-282-4410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IKRAM KHALIQ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-896-0482
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------