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General NPI Number Information
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NPI Number | 1154795557
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Entity Type | Individual
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Provider Name | JD LEE SHOULDERS PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 394 N DIXIE ST
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City | HORSE CAVE
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State | KY
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Zip | 42749-1138
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Country | US
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Telephone | 270-786-1147
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Fax | 270-786-5615
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Provider Business Mailing Address
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Address Line | 1529 NEPTUNE WAY
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City | BOWLING GREEN
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State | KY
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Zip | 42104-0210
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Country | US
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Telephone | 270-991-4696
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Fax | 270-786-5615
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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 | 009319
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License Number State | KY
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