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General NPI Number Information
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NPI Number | 1073730859
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Entity Type | Individual
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Provider Name | MR. RALPH DEMARET
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 E NORTH ST
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City | GRAYVILLE
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State | IL
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Zip | 62844-1402
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Country | US
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Telephone | 618-375-2131
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Fax | 618-375-5029
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Provider Business Mailing Address
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Address Line | RR 3 BOX 381
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City | FAIRFIELD
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State | IL
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Zip | 62837-9528
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Country | US
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Telephone | 618-842-3209
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Fax | 618-375-2131
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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 | 051029153
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License Number State | IL
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