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General NPI Number Information
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NPI Number | 1326011693
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Entity Type | Individual
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Provider Name | PATRICK NEAL FAIRLEY RPH
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2104 MASSEY AVENUE
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City | NAVAL STATION MAYPORT
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State | FL
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Zip | 32228
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Country | US
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Telephone | 904-270-4264
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Fax | 907-270-4454
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Provider Business Mailing Address
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Address Line | 4225 MARSH LANDING BLVD APT 223
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-2472
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Country | US
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Telephone | 904-270-4264
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Fax | 904-270-4454
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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 | E08842
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License Number State | MS
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