Provider Demographics
NPI:1316257207
Name:CHULINDRA, WITRA KHUNMUANG (PHARMD)
Entity type:Individual
Prefix:MR
First Name:WITRA
Middle Name:KHUNMUANG
Last Name:CHULINDRA
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 1:2109 FOX VALLEY DR SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3461
Mailing Address - Country:US
Mailing Address - Phone:507-319-9107
Mailing Address - Fax:
Practice Address - Street 1:MAYO CLINIC PHARMACY
Practice Address - Street 2:200 FIRST STREET SW
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist