MEDICARE: MR. DOMINIC JOHN PESCE 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	44779	CA

General Provider Information

NPI Number	:	1386627735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOMINIC JOHN PESCE RPH

Provider Business Mailing Address
First Line	:	4302 MOUNT HUKEE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4736
Country	:	US
Telephone Number	:	619-922-6440
Fax Number	:	858-268-3664

Provider Business Practice Location Address
First Line	:	4302 MOUNT HUKEE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4736
Country	:	US
Telephone Number	:	619-922-6440
Fax Number	:	858-268-3664

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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