1285778357 NPI number — GENE TSUNO

Table of content: (NPI 1285778357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285778357 NPI number — GENE TSUNO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENE TSUNO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EXCLUSIVE RX PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285778357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 BIRCH ST
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-1990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-660-7244
Provider Business Mailing Address Fax Number:
949-660-1260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 BIRCH ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-1990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-660-7244
Provider Business Practice Location Address Fax Number:
949-660-1260
Provider Enumeration Date:
02/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TSUNO
Authorized Official First Name:
GENE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND PHARMACIST
Authorized Official Telephone Number:
949-660-7244

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY46463 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA464630 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0537526 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".