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General NPI Number Information
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NPI Number | 1326684481
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Entity Type | Individual
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Provider Name | JESSICA DAVENPORT CPHT
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Gender | Female
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 81 COUNTY ROAD 5043
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City | CLEVELAND
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State | TX
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Zip | 77327-7732
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Country | US
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Telephone | 713-899-4082
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1081
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City | SPLENDORA
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State | TX
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Zip | 77372-1081
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Country | US
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Telephone | 713-899-4082
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Fax |
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 103897
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License Number State | TX
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