MEDICARE: SOLOMON SOV LEE PHARM D

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	54960	CA

General Provider Information

NPI Number	:	1831688878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOLOMON SOV LEE PHARM D

Provider Business Mailing Address
First Line	:	19715 GRAVINA ST
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2435
Country	:	US
Telephone Number	:	909-631-9953
Fax Number	:

Provider Business Practice Location Address
First Line	:	1366 S RIVERSIDE AVE
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92376-7608
Country	:	US
Telephone Number	:	909-820-7635
Fax Number	:	909-875-9588

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

Provider Enumeration Date	:	05/04/2018
Last Update Date	:	05/04/2018

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Directions to “ SOLOMON SOV LEE PHARM D” Practice Location

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