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General NPI Number Information
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NPI Number | 1104430867
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Entity Type | Individual
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Provider Name | MATTHEW SCOTT MONTGOMERY PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 10899 BAYMEADOWS RD
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4603
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Country | US
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Telephone | 904-519-6277
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Fax |
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Provider Business Mailing Address
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Address Line | 4429 APPLE LEAF DR E
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City | JACKSONVILLE
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State | FL
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Zip | 32224-8614
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Country | US
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Telephone | 904-570-2369
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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 | PS0036892
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License Number State | FL
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