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General NPI Number Information
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NPI Number | 1225385206
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Entity Type | Individual
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Provider Name | JASON ANDREW STUBBLEFIELD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 4529 W HILLSBORO BLVD
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2006
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Country | US
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Telephone | 954-480-9132
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Fax |
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Provider Business Mailing Address
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Address Line | 8525 OLD COUNTRY MNR APT 509
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City | DAVIE
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State | FL
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Zip | 33328-2918
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Country | US
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Telephone | 954-292-3385
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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 | PS49471
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License Number State | FL
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