Healthcare Provider Details

I. General information

NPI: 1538790118
Provider Name (Legal Business Name): MISS GRACE SEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 PROSPECT AVE APT D
SAN GABRIEL CA
91776-4422
US

IV. Provider business mailing address

1512 PROSPECT AVE APT D
SAN GABRIEL CA
91776-4422
US

V. Phone/Fax

Practice location:
  • Phone: 626-823-1189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: