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General NPI Number Information
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NPI Number | 1134164353
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Entity Type | Organization
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Legal Business Name | ASSURED PHARMACY
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10196 SW PARK WAY
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City | PORTLAND
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State | OR
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Zip | 97225-5008
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Country | US
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Telephone | 503-292-0045
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Fax | 503-292-0059
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | FRANKLIN PARK
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State | NJ
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Zip | 08823-0023
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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 | CHIEF OPS OFC
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Name | JOHN MUTTER
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Credential |
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Telephone | 949-222-9971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP0002215CS
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License Number State | OR
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