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General NPI Number Information
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NPI Number | 1245703321
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Entity Type | Individual
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Provider Name | RANDALL STUCKEY DPH
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Gender | Male
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 106 W HWY 152
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City | MUSTANG
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State | OK
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Zip | 73064
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Country | US
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Telephone | 405-376-3340
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Fax | 405-376-1390
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Provider Business Mailing Address
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Address Line | 1404 CONTINENTAL WAY
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City | MUSTANG
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State | OK
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Zip | 73064-2074
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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 |
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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 | 12048
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License Number State | OK
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