Provider Demographics
NPI:1083624092
Name:TONNU-MIHARA, IVY Q (PHARMD, MS)
Entity Type:Individual
Prefix:DR
First Name:IVY
Middle Name:Q
Last Name:TONNU-MIHARA
Suffix:
Gender:F
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:Q
Other - Last Name:TONNU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, MS
Mailing Address - Street 1:5901 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822-5201
Mailing Address - Country:US
Mailing Address - Phone:562-826-8000
Mailing Address - Fax:562-826-5797
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:562-826-5797
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528231835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist