Provider Demographics
NPI:1093108805
Name:SOLARIS PHARMACY INC
Entity Type:Organization
Organization Name:SOLARIS PHARMACY INC
Other - Org Name:SOLARIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-627-1011
Mailing Address - Street 1:91 BARNETT SHALE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2266
Mailing Address - Country:US
Mailing Address - Phone:940-208-1638
Mailing Address - Fax:940-233-1093
Practice Address - Street 1:91 BARNETT SHALE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2266
Practice Address - Country:US
Practice Address - Phone:940-208-1638
Practice Address - Fax:940-233-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2024-02-28
Deactivation Date:2024-01-19
Deactivation Code:
Reactivation Date:2024-02-23
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336M0002X
TX25715333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25715OtherPHARMACY LICENSE