MEDICARE: MR. CHARLES K TUEY PHARMD

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	1835P1200X	Pharmacotherapy Pharmacist	55059	CA

General Provider Information

NPI Number	:	1528175189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES K TUEY PHARMD

Provider Business Mailing Address
First Line	:	10272 WATERIDGE CIR UNIT 233
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-5736
Country	:	US
Telephone Number	:	858-457-8123
Fax Number	:

Provider Business Practice Location Address
First Line	:	10272 WATERIDGE CIRCLE #233
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-5736
Country	:	US
Telephone Number	:	858-457-8123
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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