Provider Demographics
NPI:1851775688
Name:SOLUS PHARMACY LLC
Entity type:Organization
Organization Name:SOLUS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-896-0482
Mailing Address - Street 1:805 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-3100
Mailing Address - Country:US
Mailing Address - Phone:856-282-4410
Mailing Address - Fax:
Practice Address - Street 1:805 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-3100
Practice Address - Country:US
Practice Address - Phone:856-282-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7458750001Medicare NSC