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General NPI Number Information
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NPI Number | 1417950387
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH DRUGS, INC.
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 204 N. MAIN ST.
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City | SAINT JOSEPH
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State | IL
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Zip | 61873-0500
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Country | US
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Telephone | 217-469-2232
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Fax | 217-469-2381
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | SAINT JOSEPH
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State | IL
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Zip | 61873-0500
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Country | US
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Telephone | 217-469-2232
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Fax | 217-469-2381
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MS. KATHLEEN A. MUNDAY
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Credential | RPH.
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Telephone | 217-469-2232
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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 | 054011849
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License Number State | IL
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