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General NPI Number Information
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NPI Number | 1275957136
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Entity Type | Organization
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Legal Business Name | PAC LP
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 9465 W POST ROAD SUITE 1068
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City | LAS VEGAS
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State | NV
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Zip | 89148-5786
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Country | US
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Telephone | 562-587-6862
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Fax | 866-645-1202
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Provider Business Mailing Address
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Address Line | PO BOX 401721
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City | LAS VEGAS
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State | NV
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Zip | 89140-1721
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Country | US
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Telephone | 800-610-6353
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. KHALID BASHIR AHMED
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Credential | MD
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Telephone | 800-610-6353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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