Provider Demographics
NPI:1770820482
Name:SOLIS, EDMUNDO B (R-PH)
Entity Type:Individual
Prefix:
First Name:EDMUNDO
Middle Name:B
Last Name:SOLIS
Suffix:
Gender:M
Credentials:R-PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2804
Mailing Address - Country:US
Mailing Address - Phone:305-865-4378
Mailing Address - Fax:305-865-6329
Practice Address - Street 1:9400 HARDING AVE
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154
Practice Address - Country:US
Practice Address - Phone:305-865-4378
Practice Address - Fax:305-865-6329
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist