Healthcare Provider Details

I. General information

NPI: 1265685051
Provider Name (Legal Business Name): S. NORMAN VAISUALA'O TUALA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 NORTH DIVISION ST. RITE AID PHARMACY
SPOKANE WA
99208-1297
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 509-489-6010
  • Fax:
Mailing address:
  • Phone: 808-433-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60025050
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: