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NPI 1407143704

NPI 1407143704 : ROBERT RITCHEY : JEFFERSON CITY, MO

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General NPI Number Information
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    NPI Number           |    1407143704
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    Entity Type          |    Individual 
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    Provider Name        |    ROBERT RITCHEY
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    07/07/2011
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    Last Update Date     |    03/04/2019
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Provider Practice Location Address
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    Address Line         |    2505 MISSION DR 
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    City                 |    JEFFERSON CITY
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    State                |    MO
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    Zip                  |    65109-9508
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    Country              |    US
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    Telephone            |    573-681-3168
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    1705 S OAKS DR 
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    City                 |    WARDSVILLE
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    State                |    MO
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    Zip                  |    65101-9780
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    Country              |    US
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    Telephone            |    573-694-9530
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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       |    2017033617
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    License Number State |    MO
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Taxonomy #2
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    Taxonomy Code        |    183500000X
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    Taxonomy Name        |    Pharmacist
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    License Number       |    051.289989
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    License Number State |    IL
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