Provider Demographics
NPI:1114477619
Name:TIET, SELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SELA
Middle Name:
Last Name:TIET
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6042 TEMPLE CITY BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3745 E FOOTHILL BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2202
Practice Address - Country:US
Practice Address - Phone:626-351-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist