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General NPI Number Information
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NPI Number | 1174699284
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Entity Type | Organization
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Legal Business Name | TLC INTEGRATIVE PHARMACY INC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 15600 NE 8TH ST STE K8
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City | BELLEVUE
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State | WA
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Zip | 98008-3927
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Country | US
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Telephone | 425-653-2323
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Fax | 425-653-3535
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Provider Business Mailing Address
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Address Line | 15600 NE 8TH ST STE K8
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City | BELLEVUE
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State | WA
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Zip | 98008-3927
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Country | US
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Telephone | 425-653-2323
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Fax | 425-653-3535
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Authorized Official
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Title or Position | OWNER PIC
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Name | DMITRY LEFELMAN
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Credential | RPH
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Telephone | 425-785-4955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | CF00058793
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License Number State | WA
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