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General NPI Number Information
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NPI Number | 1326238700
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Entity Type | Individual
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Provider Name | BRIAN THOMAS MCDONOUGH RPH
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Gender | Male
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 805 S LAKE ST
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City | GARY
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State | IN
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Zip | 46403-2918
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Country | US
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Telephone | 219-938-4857
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Fax | 219-938-4809
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Provider Business Mailing Address
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Address Line | 12705 MORNING DOVE DR
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City | CEDAR LAKE
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State | IN
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Zip | 46303-8607
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Country | US
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Telephone | 219-374-8824
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Fax | 219-374-8824
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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 | 26017473A
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License Number State | IN
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