Provider Demographics
NPI:1760298988
Name:SOL LAB LLC
Entity type:Organization
Organization Name:SOL LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEROSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-465-0755
Mailing Address - Street 1:4002 PARK ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33777
Mailing Address - Country:US
Mailing Address - Phone:813-465-0755
Mailing Address - Fax:
Practice Address - Street 1:4002 PARK ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709
Practice Address - Country:US
Practice Address - Phone:727-287-0941
Practice Address - Fax:727-287-0938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy