Provider Demographics
NPI:1588964480
Name:SUN, TYLER (RPH)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:SUN
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 1:900 MERIDIAN E
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-7001
Mailing Address - Country:US
Mailing Address - Phone:253-952-0390
Mailing Address - Fax:253-952-3545
Practice Address - Street 1:900 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-7001
Practice Address - Country:US
Practice Address - Phone:253-952-0390
Practice Address - Fax:253-952-3545
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.00004883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist