Healthcare Provider Details

I. General information

NPI: 1215988506
Provider Name (Legal Business Name): MICHAEL JOHN TUNNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 E CRAIG RD
NORTH LAS VEGAS NV
89030-3391
US

IV. Provider business mailing address

PO BOX 360001
NORTH LAS VEGAS NV
89036-8108
US

V. Phone/Fax

Practice location:
  • Phone: 702-636-3000
  • Fax: 702-636-4057
Mailing address:
  • Phone: 702-636-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5045
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11278
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: