Healthcare Provider Details

I. General information

NPI: 1053662882
Provider Name (Legal Business Name): DHANNA AYENTO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S WHITE RD
SAN JOSE CA
95127-3812
US

IV. Provider business mailing address

1030 SOUTH WHITE ROAD
SAN JOSE CA
95127
US

V. Phone/Fax

Practice location:
  • Phone: 408-258-3311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: