MEDICARE: LORI SOLOMON-GOLDBERG

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	183500000X	Pharmacist	5302023240	MI

General Provider Information

NPI Number	:	1922393586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI SOLOMON-GOLDBERG

Provider Business Mailing Address
First Line	:	30020 GRAND RIVER AVE
Second Line	:	T-0611
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-4722
Country	:	US
Telephone Number	:	247-477-1467
Fax Number	:	248-477-1467

Provider Business Practice Location Address
First Line	:	30020 GRAND RIVER AVE
Second Line	:	T-0611
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-4722
Country	:	US
Telephone Number	:	247-477-1467
Fax Number	:	248-477-1467

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2011
Last Update Date	:	06/12/2011

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Directions to “ LORI SOLOMON-GOLDBERG ” Practice Location

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