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General NPI Number Information
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NPI Number | 1225163397
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Entity Type | Individual
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Provider Name | MITCHEL WARD R. PH.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1625 W THARPE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32303-4664
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Country | US
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Telephone | 850-297-2557
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Fax |
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Provider Business Mailing Address
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Address Line | 156 CAMELLIA AVE
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City | MONTICELLO
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State | FL
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Zip | 32344-5740
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Country | US
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Telephone | 850-997-5243
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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 | RPH011245
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License Number State | GA
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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 | PS0014662
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License Number State | FL
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