MEDICARE: DR. CARLTON MATTHEW THYGESEN

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	9481	NE

General Provider Information

NPI Number	:	1467452458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLTON MATTHEW THYGESEN

Provider Business Mailing Address
First Line	:	5045 SAWGRASS DR
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68526-9677
Country	:	US
Telephone Number	:	402-483-4964
Fax Number	:	402-483-5533

Provider Business Practice Location Address
First Line	:	5045 SAWGRASS DR
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68526-9677
Country	:	US
Telephone Number	:	402-483-4964
Fax Number	:	402-483-5533

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

Provider Enumeration Date	:	07/31/2005
Last Update Date	:	07/08/2007

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