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General NPI Number Information
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NPI Number | 1396590527
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Entity Type | Individual
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Provider Name | COCANUT MOHAMMED SUHAIL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 200 N HURSTBOURNE PKWY STE 174
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City | LOUISVILLE
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State | KY
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Zip | 40222-5138
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Country | US
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Telephone | 844-552-9669
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Fax | 502-690-4466
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Provider Business Mailing Address
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Address Line | 3164 ROUNDWAY DOWN LN
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City | LEXINGTON
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State | KY
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Zip | 40509-8527
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Country | US
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Telephone | 502-648-7632
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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 | I15156
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License Number State | KY
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