MEDICARE: SOLANTIC OF ORLANDO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	HCC 8282	FL

General Provider Information

NPI Number	:	1649594706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLANTIC OF ORLANDO LLC

Provider Business Mailing Address
First Line	:	8711 PERIMETER PARK BLVD
Second Line	:	SUITE 6
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6388
Country	:	US
Telephone Number	:	904-223-2330
Fax Number	:	904-425-4356

Provider Business Practice Location Address
First Line	:	7751 KINGSPOINTE PKWY
Second Line	:	# 114
City	:	ORLANDO
State	:	FL
Zip	:	32819-6500
Country	:	US
Telephone Number	:	407-581-9672
Fax Number	:	407-581-9673

Authorized Official
Title or Position	:	CEO
Name	:	KAREN BOWLING
Credential	:
Telephone Number	:	904-223-2330

Provider Enumeration Date	:	03/18/2010
Last Update Date	:	03/18/2010

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