Healthcare Provider Details

I. General information

NPI: 1174699284
Provider Name (Legal Business Name): TLC INTEGRATIVE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 NE 8TH ST STE K8
BELLEVUE WA
98008-3927
US

IV. Provider business mailing address

15600 NE 8TH ST STE K8
BELLEVUE WA
98008-3927
US

V. Phone/Fax

Practice location:
  • Phone: 425-653-2323
  • Fax: 425-653-3535
Mailing address:
  • Phone: 425-653-2323
  • Fax: 425-653-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00058793
License Number StateWA

VIII. Authorized Official

Name: DMITRY LEFELMAN
Title or Position: OWNER PIC
Credential: RPH
Phone: 425-785-4955