Basic Information
| Provider Information | |||||||||
| NPI: | 1306995402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TSE | ||||||||
| FirstName: | MEI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3710 SW US VETERANS HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972392964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032208262 | ||||||||
| FaxNumber: | 5034022919 | ||||||||
| Practice Location | |||||||||
| Address1: | 3710 SW US VETERANS HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972392964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032208262 | ||||||||
| FaxNumber: | 5034022919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 53822 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.