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General NPI Number Information
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NPI Number | 1255614467
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Entity Type | Individual
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Provider Name | MARK STEVEN SIPE
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Gender | Male
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 1243 STATE ROUTE 28
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City | MILFORD
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State | OH
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Zip | 45150-2248
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Country | US
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Telephone | 513-575-3469
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Fax |
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Provider Business Mailing Address
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Address Line | 1768 HERITAGE WOODS DR
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City | GOSHEN
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State | OH
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Zip | 45122-9475
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Country | US
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Telephone | 513-625-2258
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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 | 03-1-12419
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 008801
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License Number State | KY
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