Provider Demographics
NPI:1922393586
Name:SOLOMON-GOLDBERG, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SOLOMON-GOLDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30020 GRAND RIVER AVE
Mailing Address - Street 2:T-0611
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-4722
Mailing Address - Country:US
Mailing Address - Phone:247-477-1467
Mailing Address - Fax:248-477-1467
Practice Address - Street 1:30020 GRAND RIVER AVE
Practice Address - Street 2:T-0611
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-4722
Practice Address - Country:US
Practice Address - Phone:247-477-1467
Practice Address - Fax:248-477-1467
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist