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General NPI Number Information
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NPI Number | 1154525483
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Entity Type | Individual
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Provider Name | MICHAEL ANDREW WANLESS PHARM. D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2220 SUNSET BLVD
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City | ROCKLIN
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State | CA
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Zip | 95765-4270
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Country | US
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Telephone | 916-789-0807
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Fax | 916-789-0809
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Provider Business Mailing Address
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Address Line | 1640 GOLDSTAR ST
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City | ROSEVILLE
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State | CA
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Zip | 95747-4901
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Country | US
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Telephone | 916-768-2736
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Fax | 916-774-0975
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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 | RPH53843
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License Number State | CA
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