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General NPI Number Information
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NPI Number | 1235466061
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Entity Type | Organization
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Legal Business Name | MEDCARE CLINIC & PHARMACY LLC
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 7892 IDLEWILD RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8675
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Country | US
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Telephone | 704-882-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 7892 IDLEWILD RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8675
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST MANAGER
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Name | JAMES GRANT DOROUGH
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Credential | PHARMACIST
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Telephone | 704-882-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 10397
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License Number State | NC
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