Healthcare Provider Details

I. General information

NPI: 1083624092
Provider Name (Legal Business Name): IVY Q TONNU-MIHARA PHARM.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IVY Q TONNU PHARM.D., M.S.

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-826-5797
Mailing address:
  • Phone: 562-826-8000
  • Fax: 562-826-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number52823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: