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General NPI Number Information
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NPI Number | 1023485539
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Entity Type | Organization
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Legal Business Name | CVS
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 6480 OLD WATERLOO ROAD
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City | ELKRIDGE
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State | MD
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Zip | 21075
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Country | US
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Telephone | 410-799-0291
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Fax |
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Provider Business Mailing Address
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Address Line | 8839 STONEBROOK LN
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City | COLUMBIA
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State | MD
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Zip | 21046-1415
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Country | US
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Telephone | 919-449-6230
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Fax |
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | JENNIFER REZAKHAN
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Credential |
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Telephone | 443-716-5153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 23561
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License Number State | MD
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