MEDICARE: THERESA LIN

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	62954	CA

General Provider Information

NPI Number	:	1457809386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA LIN

Provider Business Mailing Address
First Line	:	1741 GRANVILLE AVE APT 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 GRANVILLE AVE APT 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1875
Country	:	US
Telephone Number	:	818-458-0706
Fax Number	:

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/20/2016

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Directions to “ THERESA LIN ” Practice Location

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