Provider Demographics
NPI:1760935258
Name:CHUN, DERRICK JKL (PHARMD)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:JKL
Last Name:CHUN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 CHAPEL HILL BLVD APT K303
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3879
Mailing Address - Country:US
Mailing Address - Phone:808-224-7605
Mailing Address - Fax:
Practice Address - Street 1:585 GAGE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7761
Practice Address - Country:US
Practice Address - Phone:509-628-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60669120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist