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General NPI Number Information
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NPI Number | 1306867379
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Entity Type | Organization
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Legal Business Name | MISSION HOSPICE LLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1608 NW EXPRESSWAY ST STE B
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City | OKLAHOMA CITY
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State | OK
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Zip | 73118-1402
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Country | US
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Telephone | 405-841-3841
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Fax | 405-841-3843
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Provider Business Mailing Address
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Address Line | 1608 NW EXPRESSWAY ST STE B
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City | OKLAHOMA CITY
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State | OK
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Zip | 73118-1402
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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 | PHARMACIST MANAGER
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Name | DEANNE JACOBS
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Credential | DPH
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Telephone | 405-841-3841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | 15156
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License Number State | OK
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