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General NPI Number Information
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NPI Number | 1023884020
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Entity Type | Individual
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Provider Name | JUSTINE LAURELL RAY PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 11/30/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 2580 CRAWFORDVILLE HWY FL 32327
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City | CRAWFORDVILLE
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State | FL
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Zip | 32327-2174
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Country | US
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Telephone | 850-926-2754
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 SYLVAN CT
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City | TALLAHASSEE
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State | FL
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Zip | 32303-3729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS66639
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License Number State | FL
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