Provider Demographics
NPI:1841154358
Name:SOLISA LLC
Entity type:Organization
Organization Name:SOLISA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DYAL-GUALBANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-960-5201
Mailing Address - Street 1:5624 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6217
Mailing Address - Country:US
Mailing Address - Phone:516-960-5201
Mailing Address - Fax:
Practice Address - Street 1:5624 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6217
Practice Address - Country:US
Practice Address - Phone:516-960-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy