Provider Demographics
NPI:1154921229
Name:SOLOMON, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4415
Mailing Address - Country:US
Mailing Address - Phone:308-236-8547
Mailing Address - Fax:308-237-0933
Practice Address - Street 1:2516 2ND AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4415
Practice Address - Country:US
Practice Address - Phone:308-236-8547
Practice Address - Fax:308-237-0933
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist