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General NPI Number Information
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NPI Number | 1245978014
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Entity Type | Individual
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Provider Name | MUTAHIR NIAZ
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Gender | Male
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 289 POST RD E
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City | WESTPORT
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State | CT
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Zip | 06880-3613
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Country | US
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Telephone | 203-226-0741
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Fax |
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Provider Business Mailing Address
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Address Line | 5742 MEMORIAL BLVD
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City | SAINT GEORGE
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State | SC
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Zip | 29477-2153
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Country | US
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Telephone | 843-563-2208
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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 | 43432
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License Number State | SC
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