Provider Demographics
NPI:1093039141
Name:SOLANTIC OF ORLANDO, LLC
Entity Type:Organization
Organization Name:SOLANTIC OF ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-223-2330
Mailing Address - Street 1:8711 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6388
Mailing Address - Country:US
Mailing Address - Phone:904-223-2330
Mailing Address - Fax:904-425-4356
Practice Address - Street 1:3840 E STATE ROAD 436
Practice Address - Street 2:SUITE 1000
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6197
Practice Address - Country:US
Practice Address - Phone:407-478-3202
Practice Address - Fax:407-478-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 8433333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy