Provider Demographics
NPI:1861052300
Name:SOLIS, DIANA J (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:J
Last Name:SOLIS
Suffix:
Gender:F
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 1:5654 BENGAL PL
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2555
Mailing Address - Country:US
Mailing Address - Phone:703-338-5741
Mailing Address - Fax:
Practice Address - Street 1:21398 PRICE CASCADES PLZ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6606
Practice Address - Country:US
Practice Address - Phone:703-406-7048
Practice Address - Fax:703-406-7045
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28684OtherNORTH CAROLINA BOARD OF PHARMACY