=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225414311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAO HA PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2015
-----------------------------------------------------
Last Update Date | 10/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9961 SIERRA AVE
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92335-6720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-427-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5233 BARTLETT AVE
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91776-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-542-5788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 66100
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------