MEDICARE: DR. CHARLES RAY WALL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	11981	AL

General Provider Information

NPI Number	:	1770792871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES RAY WALL RPH

Provider Business Mailing Address
First Line	:	6441 MONT RICHER AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-9325
Country	:	US
Telephone Number	:	865-689-9778
Fax Number	:

Provider Business Practice Location Address
First Line	:	727 MEMORIAL DR
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-6029
Country	:	US
Telephone Number	:	205-481-2040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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