Provider Demographics
NPI:1285778357
Name:GENE TSUNO
Entity type:Organization
Organization Name:GENE TSUNO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUNO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:949-660-7244
Mailing Address - Street 1:4501 BIRCH ST
Mailing Address - Street 2:STE B
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1990
Mailing Address - Country:US
Mailing Address - Phone:949-660-7244
Mailing Address - Fax:949-660-1260
Practice Address - Street 1:4501 BIRCH ST
Practice Address - Street 2:STE B
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1990
Practice Address - Country:US
Practice Address - Phone:949-660-7244
Practice Address - Fax:949-660-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336M0002X
CAPHY464633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA464630Medicaid
0537526OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0537526OtherNCPDP PROVIDER IDENTIFICATION NUMBER