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General NPI Number Information
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NPI Number | 1134428303
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Entity Type | Individual
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Provider Name | NEALAN RAY HENDERSON RPH
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Gender | Male
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Dates
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Enumeration Date | 03/26/2011
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Last Update Date | 03/26/2011
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Provider Practice Location Address
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Address Line | 230 REDWOOD HWY
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City | GRANTS PASS
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State | OR
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Zip | 97527-5404
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Country | US
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Telephone | 541-479-8337
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Fax | 541-476-1443
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Provider Business Mailing Address
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Address Line | 158 WHISPERING DR
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City | GRANTS PASS
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State | OR
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Zip | 97527-9084
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Country | US
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Telephone | 541-476-6826
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Fax | 541-476-6826
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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 | 6730
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License Number State | OR
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