MEDICARE: MR. DOMINICK W TSE RPH

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	31763	CA

General Provider Information

NPI Number	:	1538461280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOMINICK W TSE RPH

Provider Business Mailing Address
First Line	:	811 HOLLENBECK AVE
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-1874
Country	:	US
Telephone Number	:	408-636-6991
Fax Number	:

Provider Business Practice Location Address
First Line	:	639 S BERNARDO AVE
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-1020
Country	:	US
Telephone Number	:	408-732-5902
Fax Number	:	408-732-5914

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	11/03/2011

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