Provider Demographics
NPI:1780707083
Name:LUK, WAYNE TIM (RPH)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:TIM
Last Name:LUK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 NW RANDALL WAY
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7952
Mailing Address - Country:US
Mailing Address - Phone:360-536-6010
Mailing Address - Fax:360-536-9100
Practice Address - Street 1:3201 NW RANDALL WAY
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7952
Practice Address - Country:US
Practice Address - Phone:360-536-6010
Practice Address - Fax:360-536-9100
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist