=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649534108
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOAI-AN TON-NU PHARMACIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2012
-----------------------------------------------------
Last Update Date | 06/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31625 HIGHWAY 101 S
-----------------------------------------------------
City | SOLEDAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93960-9529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-678-5500
-----------------------------------------------------
Fax | 831-678-5266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1380 JAMES CT
-----------------------------------------------------
City | MORGAN HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95037-3366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-678-5500
-----------------------------------------------------
Fax | 408-516-9849
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH41718
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | RPH41718
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------