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General NPI Number Information
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NPI Number | 1265052377
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Entity Type | Individual
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Provider Name | WARINSIRI VONGNALITH RPH
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Gender | Female
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Dates
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Enumeration Date | 04/18/2020
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Last Update Date | 04/18/2020
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Provider Practice Location Address
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Address Line | 10451 FAIRWAY DR
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City | ROSEVILLE
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State | CA
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Zip | 95678-1987
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Country | US
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Telephone | 916-780-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 8971 SHASTA LILY DR
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City | ELK GROVE
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State | CA
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Zip | 95624-3870
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Country | US
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Telephone | 916-897-6493
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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 | 81722
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License Number State | CA
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