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General NPI Number Information
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NPI Number | 1467505917
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Entity Type | Individual
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Provider Name | DOUGLAS EUGENE NYKANEN R.PH.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 CASCADE ST N
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City | OSCEOLA
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State | WI
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Zip | 54020
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Country | US
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Telephone | 715-294-2110
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Fax | 715-294-1617
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Provider Business Mailing Address
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Address Line | 733 MAPLE LEAF DR
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City | OSCEOLA
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State | WI
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Zip | 54020-4302
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Country | US
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Telephone | 715-294-2766
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Fax | 715-294-1617
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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 | 7702-040
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License Number State | WI
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