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General NPI Number Information
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NPI Number | 1356159164
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Entity Type | Organization
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Legal Business Name | WILMORE PHARMACIST GROUP, LLC
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 201 E MAIN ST
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City | WILMORE
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State | KY
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Zip | 40390-1321
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Country | US
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Telephone | 859-859-2453
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Fax | 859-858-2436
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Provider Business Mailing Address
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Address Line | 201 E MAIN ST
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City | WILMORE
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State | KY
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Zip | 40390-1321
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Country | US
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Telephone | 859-858-2453
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Fax | 859-858-2436
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Authorized Official
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Title or Position | OWNER
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Name | JOHN JASON MCDANIEL
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Credential |
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Telephone | 859-858-2453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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