Healthcare Provider Details

I. General information

NPI: 1114477619
Provider Name (Legal Business Name): SELA TIET PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 E FOOTHILL BLVD UNIT D
PASADENA CA
91107-2202
US

IV. Provider business mailing address

6042 TEMPLE CITY BLVD APT D
TEMPLE CITY CA
91780-2053
US

V. Phone/Fax

Practice location:
  • Phone: 626-351-0515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: