Provider Demographics
NPI:1568179406
Name:SOLOMON, BARRY (BS, MA)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:BS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 BATAAN RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1404
Mailing Address - Country:US
Mailing Address - Phone:310-422-4635
Mailing Address - Fax:
Practice Address - Street 1:2219 BATAAN RD # B
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-1404
Practice Address - Country:US
Practice Address - Phone:310-422-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20663OtherCA STATE BOARD OF PHARMACY LICENSE NUMBER