MEDICARE: MR. DICK MITSURU NISHIMOTO DR. OF PHARM.

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	RPH32073	CA

General Provider Information

NPI Number	:	1851681472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DICK MITSURU NISHIMOTO DR. OF PHARM.

Provider Business Mailing Address
First Line	:	1333 S WINCHESTER BLVD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-4343
Country	:	US
Telephone Number	:	408-379-6570
Fax Number	:	408-379-0107

Provider Business Practice Location Address
First Line	:	1333 S WINCHESTER BLVD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-4343
Country	:	US
Telephone Number	:	408-379-6570
Fax Number	:	408-379-0107

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

Provider Enumeration Date	:	04/15/2011
Last Update Date	:	04/15/2011

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