Provider Demographics
NPI:1407566979
Name:TSE, CHANEL Z
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:Z
Last Name:TSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 DE LA FUENTE ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2623
Mailing Address - Country:US
Mailing Address - Phone:626-408-4752
Mailing Address - Fax:
Practice Address - Street 1:2555 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4805
Practice Address - Country:US
Practice Address - Phone:707-269-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist