Provider Demographics
NPI:1780170225
Name:SOLOMON, RAVEN (PHARMD)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 BRECKENRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4233
Mailing Address - Country:US
Mailing Address - Phone:813-304-2221
Mailing Address - Fax:855-510-5400
Practice Address - Street 1:5908 BRECKENRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4233
Practice Address - Country:US
Practice Address - Phone:813-304-2221
Practice Address - Fax:855-510-5400
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist