MEDICARE: SELA TIET PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	75408	CA

General Provider Information

NPI Number	:	1114477619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELA TIET PHARM.D.

Provider Business Mailing Address
First Line	:	6042 TEMPLE CITY BLVD APT D
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3745 E FOOTHILL BLVD
Second Line	:	UNIT D
City	:	PASADENA
State	:	CA
Zip	:	91107-2202
Country	:	US
Telephone Number	:	626-351-0515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	10/07/2016

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