Provider Demographics
NPI:1871105114
Name:SOLOMON, SAM NII AHIA (PHARM D)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:NII AHIA
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3612
Mailing Address - Country:US
Mailing Address - Phone:706-647-4000
Mailing Address - Fax:706-647-4020
Practice Address - Street 1:634 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3612
Practice Address - Country:US
Practice Address - Phone:706-647-4000
Practice Address - Fax:706-647-4020
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist