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General NPI Number Information
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NPI Number | 1205464658
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Entity Type | Organization
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Legal Business Name | PROACTIVE CARE PHARMACY, LLC.
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 7345 LINDA VISTA RD STE E
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City | SAN DIEGO
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State | CA
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Zip | 92111-5800
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Country | US
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Telephone | 858-405-4675
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Fax |
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Provider Business Mailing Address
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Address Line | 11859 TRAIL CREST DR
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City | SAN DIEGO
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State | CA
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Zip | 92131-6147
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Country | US
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Telephone | 858-405-6759
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANH PHAM
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Credential | RPH
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Telephone | 858-405-6759
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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 |
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License Number State |
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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 |
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License Number State |
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