Healthcare Provider Details

I. General information

NPI: 1124531611
Provider Name (Legal Business Name): DIEUMY TONNU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 649
FORT DEFIANCE AZ
86504-0649
US

IV. Provider business mailing address

2617 PARK DR
SANTA ANA CA
92707-3318
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: