Provider Demographics
NPI:1629746565
Name:TEA, VICKI DEBBRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:DEBBRA
Last Name:TEA
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 1:1000 N OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1347
Mailing Address - Country:US
Mailing Address - Phone:626-688-8854
Mailing Address - Fax:
Practice Address - Street 1:1625 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4226
Practice Address - Country:US
Practice Address - Phone:213-482-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH84870333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy