Provider Demographics
NPI:1558136309
Name:SOLTAN, JAN ANDRZEJ (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:ANDRZEJ
Last Name:SOLTAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30411 LAPASSADE CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3596
Mailing Address - Country:US
Mailing Address - Phone:708-502-4779
Mailing Address - Fax:
Practice Address - Street 1:36919 COOK ST STE 102
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6069
Practice Address - Country:US
Practice Address - Phone:760-340-3248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist