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General NPI Number Information
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NPI Number | 1275697823
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Entity Type | Organization
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Legal Business Name | MIDDLE VILLAGE PHARMACY
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7404 METROPOLITAN AVE
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-2637
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Country | US
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Telephone | 718-326-3702
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Fax | 718-326-3059
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Provider Business Mailing Address
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Address Line | 7404 METROPOLITAN AVE
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-2637
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Country | US
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Telephone | 718-326-3702
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Fax | 718-326-3059
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Authorized Official
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Title or Position | SUPERVISOR PHARMACIST
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Name | FAUSTINE MAI LUU
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Credential | R.P.H
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Telephone | 718-326-3072
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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 | 042918-1
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License Number State | NY
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