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General NPI Number Information
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NPI Number | 1285157792
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Entity Type | Organization
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Legal Business Name | CLAIBORNE LTC PHARMACY, LLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 831 W MAIN ST
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City | HOMER
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State | LA
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Zip | 71040-3322
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Country | US
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Telephone | 318-927-3523
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 729
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City | BENTON
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State | LA
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Zip | 71006-0729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN BANNISTER
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Credential |
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Telephone | 318-927-3523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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