Provider Demographics
NPI:1831688878
Name:LEE, SOLOMON SOV (PHARM D)
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:SOV
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19715 GRAVINA ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2435
Mailing Address - Country:US
Mailing Address - Phone:909-631-9953
Mailing Address - Fax:
Practice Address - Street 1:1366 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7608
Practice Address - Country:US
Practice Address - Phone:909-820-7635
Practice Address - Fax:909-875-9588
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty