Provider Demographics
NPI:1750506903
Name:NAGASE, GENE TSUTOMU (BS)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:TSUTOMU
Last Name:NAGASE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:NAGASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1335 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4277
Mailing Address - Country:US
Mailing Address - Phone:415-921-5502
Mailing Address - Fax:415-921-8566
Practice Address - Street 1:1335 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4277
Practice Address - Country:US
Practice Address - Phone:415-921-5502
Practice Address - Fax:415-921-8566
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist