Provider Demographics
NPI:1093152753
Name:TUN, WAI WAI (PHARMD)
Entity Type:Individual
Prefix:
First Name:WAI WAI
Middle Name:
Last Name:TUN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 S 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2816
Mailing Address - Country:US
Mailing Address - Phone:719-289-6104
Mailing Address - Fax:
Practice Address - Street 1:2028 E ISAACS AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2214
Practice Address - Country:US
Practice Address - Phone:719-289-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist