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General NPI Number Information
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NPI Number | 1336562164
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Entity Type | Individual
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Provider Name | RONALD ANDREW MAXWELL PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 1233 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82601-2926
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Country | US
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Telephone | 307-577-2072
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 BROOKVIEW DR
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City | CASPER
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State | WY
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Zip | 82604-4806
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Country | US
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Telephone | 307-259-1937
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2899
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License Number State | WY
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