Healthcare Provider Details

I. General information

NPI: 1437671591
Provider Name (Legal Business Name): JOHN CHARLES BUENO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W NAPA ST
SONOMA CA
95476-6643
US

IV. Provider business mailing address

201 W NAPA ST
SONOMA CA
95476-6643
US

V. Phone/Fax

Practice location:
  • Phone: 707-938-4734
  • Fax: 707-938-4921
Mailing address:
  • Phone: 707-938-4734
  • Fax: 707-938-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: