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General NPI Number Information
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NPI Number | 1023438439
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Entity Type | Organization
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Legal Business Name | SUNRIVER PHARMACY
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 56890 VENTURE LANE
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City | SUNRIVER
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State | OR
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Zip | 97707
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Country | US
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Telephone | 541-621-1953
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4789
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City | SUNRIVER
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State | OR
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Zip | 97707-1789
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Country | US
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Telephone | 541-621-1953
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY LOUIS GILBERT
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Credential |
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Telephone | 541-621-1953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State | OR
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