Healthcare Provider Details

I. General information

NPI: 1881248375
Provider Name (Legal Business Name): SETA SETRAK PHARMACY TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W KENNETH RD
GLENDALE CA
91201-1422
US

IV. Provider business mailing address

1012 S ADAMS ST APT 4
GLENDALE CA
91205-4407
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-4158
  • Fax: 818-247-8593
Mailing address:
  • Phone: 818-549-1358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number66162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: