MEDICARE: MR. CHARLES DWIGHT TIPTON 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	7752	AL

General Provider Information

NPI Number	:	1063519007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES DWIGHT TIPTON RPH

Provider Business Mailing Address
First Line	:	2701 PATTON RD SW
Second Line	:	SUITE E
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-4352
Country	:	US
Telephone Number	:	256-536-1910
Fax Number	:	256-536-1722

Provider Business Practice Location Address
First Line	:	2701 PATTON RD SW
Second Line	:	SUITE E
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-4352
Country	:	US
Telephone Number	:	256-536-1910
Fax Number	:	256-536-1722

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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