Healthcare Provider Details

I. General information

NPI: 1013920586
Provider Name (Legal Business Name): DIANE HAO TONNU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIRCLE
FAIRFIELD CA
94533
US

IV. Provider business mailing address

101 BODIN CIRCLE PHARMACY
FAIRFIELD CA
94533
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7657
  • Fax:
Mailing address:
  • Phone: 707-423-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42932
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: