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General NPI Number Information
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NPI Number | 1316257207
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Entity Type | Individual
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Provider Name | WITRA KHUNMUANG CHULINDRA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | MAYO CLINIC PHARMACY 200 FIRST STREET SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-284-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 FOX VALLEY DR SW
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City | ROCHESTER
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State | MN
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Zip | 55902-3461
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Country | US
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Telephone | 507-319-9107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 117887
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License Number State | MN
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