Provider Demographics
NPI:1649445552
Name:TUETKEN, CHRISTOPHER P (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:TUETKEN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1238
Mailing Address - Country:US
Mailing Address - Phone:319-221-1050
Mailing Address - Fax:319-221-1053
Practice Address - Street 1:207 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1238
Practice Address - Country:US
Practice Address - Phone:319-221-1050
Practice Address - Fax:319-221-1053
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist