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General NPI Number Information
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NPI Number | 1134231129
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Entity Type | Organization
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Legal Business Name | M.A.C.T. HEALTH BOARD, INCORPORATED
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 307 PRESTON AVE
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City | IONE
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State | CA
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Zip | 95640-9158
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Country | US
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Telephone | 209-274-2432
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Fax | 209-274-6165
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Provider Business Mailing Address
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Address Line | PO BOX 939
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City | ANGELS CAMP
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State | CA
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Zip | 95222-0939
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Country | US
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Telephone | 209-754-6262
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Fax | 209-398-8760
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHN SHAWVER ALEXANDER
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Credential |
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Telephone | 209-754-6262
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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 |
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License Number State |
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