MEDICARE: JIMMY SON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	80653	CA

General Provider Information

NPI Number	:	1558916346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY SON RPH

Provider Business Mailing Address
First Line	:	20838 NECTAR AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90715-1228
Country	:	US
Telephone Number	:	562-607-9722
Fax Number	:

Provider Business Practice Location Address
First Line	:	5670 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3904
Country	:	US
Telephone Number	:	562-930-1280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	08/07/2019

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Directions to “ JIMMY SON RPH” Practice Location

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