Provider Demographics
NPI:1609923762
Name:SOLOMON PHARMACY CORPORATION
Entity type:Organization
Organization Name:SOLOMON PHARMACY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEONG MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-321-2526
Mailing Address - Street 1:3704 UNION ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4118
Mailing Address - Country:US
Mailing Address - Phone:718-321-2526
Mailing Address - Fax:718-463-5525
Practice Address - Street 1:3704 UNION ST FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4118
Practice Address - Country:US
Practice Address - Phone:718-321-2526
Practice Address - Fax:718-463-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0208663336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01241863Medicaid
2066943OtherPK
NY01241863Medicaid
3398256OtherOTHER ID NUMBER-COMMERCIAL NUMBER