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General NPI Number Information
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NPI Number | 1457902330
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Entity Type | Individual
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Provider Name | AMANDA MONIQUE WALKER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 07/24/2022
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Provider Practice Location Address
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Address Line | 13401 OLD GLENN HWY
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7565
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Country | US
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Telephone | 907-689-4033
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504-0860
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Country | US
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Telephone | 352-256-0342
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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 | 42278
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License Number State | SC
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