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General NPI Number Information
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NPI Number | 1437305547
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Entity Type | Individual
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Provider Name | MICHAEL S. DUFORT RPH, FACA
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Gender | Male
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Dates
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Enumeration Date | 08/09/2008
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 133 PARK ST ALICE HYDE MEDICAL CENTER
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City | MALONE
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State | NY
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Zip | 12953-1243
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Country | US
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Telephone | 518-481-2255
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Fax | 518-481-2485
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Provider Business Mailing Address
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Address Line | PO BOX 42
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City | WHIPPLEVILLE
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State | NY
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Zip | 12995-0042
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Country | US
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Telephone | 518-524-6700
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Fax | 206-666-4064
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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 | 046794
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License Number State | NY
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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 | 033-0003492
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License Number State | VT
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