Provider Demographics
NPI:1043410996
Name:SOLAUN, TERSA MARIA (PH)
Entity Type:Individual
Prefix:MS
First Name:TERSA
Middle Name:MARIA
Last Name:SOLAUN
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6887 W 30TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5282
Mailing Address - Country:US
Mailing Address - Phone:305-431-5518
Mailing Address - Fax:305-485-1150
Practice Address - Street 1:9740 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4080
Practice Address - Country:US
Practice Address - Phone:305-222-2880
Practice Address - Fax:305-485-1150
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist