Provider Demographics
NPI:1619262193
Name:SELAG, VICTOR (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:SELAG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 SEPULVEDA BLVD
Mailing Address - Street 2:T0200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2606
Mailing Address - Country:US
Mailing Address - Phone:310-370-1021
Mailing Address - Fax:310-370-1021
Practice Address - Street 1:3433 SEPULVEDA BLVD
Practice Address - Street 2:T0200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2606
Practice Address - Country:US
Practice Address - Phone:310-370-1021
Practice Address - Fax:310-370-1021
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA48090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist