Provider Demographics
NPI:1588965859
Name:SOLA, ANTONELLA
Entity type:Individual
Prefix:
First Name:ANTONELLA
Middle Name:
Last Name:SOLA
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:PO BOX 2221
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302-2221
Mailing Address - Country:US
Mailing Address - Phone:928-776-4874
Mailing Address - Fax:
Practice Address - Street 1:518 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3436
Practice Address - Country:US
Practice Address - Phone:928-776-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist