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General NPI Number Information
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NPI Number | 1225173339
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Entity Type | Individual
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Provider Name | TRACY T CUSHMAN RPH
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 584 MORRIS MAJESTIC RD
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City | MORRIS
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State | AL
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Zip | 35116
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Country | US
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Telephone | 205-647-0515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222
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City | MOUNT OLIVE
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State | AL
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Zip | 35117
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Country | US
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Telephone | 205-608-0288
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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 | 11788
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License Number State | AL
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