Provider Demographics
NPI:1851681472
Name:NISHIMOTO, DICK MITSURU (DR OF PHARM)
Entity Type:Individual
Prefix:MR
First Name:DICK
Middle Name:MITSURU
Last Name:NISHIMOTO
Suffix:
Gender:M
Credentials:DR OF PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4343
Mailing Address - Country:US
Mailing Address - Phone:408-379-6570
Mailing Address - Fax:408-379-0107
Practice Address - Street 1:1333 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4343
Practice Address - Country:US
Practice Address - Phone:408-379-6570
Practice Address - Fax:408-379-0107
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH32073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist