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General NPI Number Information
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NPI Number | 1194154831
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Entity Type | Organization
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Legal Business Name | OPTIMUM CARE PHARMACY
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 2405 E MOODY BLVD
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City | BUNNELL
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State | FL
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Zip | 32110-5985
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Country | US
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Telephone | 386-627-8595
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Fax |
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Provider Business Mailing Address
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Address Line | 15 WARREN PL
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City | PALM COAST
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State | FL
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Zip | 32164-7659
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Country | US
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Telephone | 386-627-8595
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | FLORA NDUM
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Credential | PHARMD
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Telephone | 386-627-8595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PH27154
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH27154
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License Number State | FL
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