Healthcare Provider Details

I. General information

NPI: 1558136309
Provider Name (Legal Business Name): JAN SOLTAN PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 SLATE AVE STE 100
RIVERSIDE CA
92505-5198
US

IV. Provider business mailing address

30411 LAPASSADE CT
MURRIETA CA
92563-3596
US

V. Phone/Fax

Practice location:
  • Phone: 951-499-4911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: