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General NPI Number Information
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NPI Number | 1205486792
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Entity Type | Individual
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Provider Name | MARISSA GOAD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 05/01/2022
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Provider Practice Location Address
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Address Line | 4102 PINION DR
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City | USAF ACADEMY
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State | CO
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Zip | 80840-2502
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Country | US
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Telephone | 719-333-2025
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Fax |
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Provider Business Mailing Address
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Address Line | 600 MARSHALL RD
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City | SUPERIOR
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State | CO
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Zip | 80027-9730
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Country | US
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Telephone | 720-587-1000
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Fax |
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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 | S024277
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHA.0023485
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License Number State | CO
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