Provider Demographics
NPI:1679905285
Name:SOLOMON, JEFFREY DAVID (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 LAURIE LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-1823
Mailing Address - Country:US
Mailing Address - Phone:203-506-0435
Mailing Address - Fax:203-882-5775
Practice Address - Street 1:480 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2529
Practice Address - Country:US
Practice Address - Phone:203-877-7828
Practice Address - Fax:203-882-5775
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7209183500000X
NY38206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT522759OtherNABP