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General NPI Number Information
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NPI Number | 1083986814
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Entity Type | Individual
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Provider Name | DENNIS MARTIN SLOVACEK RPH
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Gender | Male
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 1400 E IRELAND RD
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City | SOUTH BEND
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State | IN
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Zip | 46614-3452
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Country | US
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Telephone | 574-231-8258
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Fax |
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Provider Business Mailing Address
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Address Line | 2270 W 400 N
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-6103
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Country | US
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Telephone | 762-362-6482
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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 | 26091690A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051026948
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License Number State | IL
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