Provider Demographics
NPI:1104206382
Name:SOLVENCY HEALTH LLC
Entity Type:Organization
Organization Name:SOLVENCY HEALTH LLC
Other - Org Name:SOLVENCY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGDALIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-333-0131
Mailing Address - Street 1:7 BALA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3205
Mailing Address - Country:US
Mailing Address - Phone:610-713-5661
Mailing Address - Fax:610-713-5720
Practice Address - Street 1:7 BALA AVE STE 100
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3205
Practice Address - Country:US
Practice Address - Phone:610-713-5661
Practice Address - Fax:610-713-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X, 3336S0011X
PAPP4825583336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030264980001Medicaid
2152377OtherPK