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General NPI Number Information
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NPI Number | 1114477619
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Entity Type | Individual
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Provider Name | SELA TIET PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 3745 E FOOTHILL BLVD UNIT D
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City | PASADENA
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State | CA
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Zip | 91107-2202
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Country | US
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Telephone | 626-351-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 6042 TEMPLE CITY BLVD APT D
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City | TEMPLE CITY
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State | CA
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Zip | 91780-2053
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 75408
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License Number State | CA
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