Provider Demographics
NPI:1952759383
Name:SOLOMON, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:MCKAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8730 W DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5108
Mailing Address - Country:US
Mailing Address - Phone:847-296-3678
Mailing Address - Fax:847-296-1658
Practice Address - Street 1:8730 W DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5108
Practice Address - Country:US
Practice Address - Phone:847-296-3678
Practice Address - Fax:847-296-1658
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051031803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist