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General NPI Number Information
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NPI Number | 1477882801
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Entity Type | Individual
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Provider Name | GINA M MANNINO PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 1015 NE RICE RD
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City | LEES SUMMIT
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State | MO
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Zip | 64086-6360
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Country | US
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Telephone | 816-525-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 919 BIRCHWOOD DR
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City | RAYMORE
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State | MO
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Zip | 64083-8582
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Country | US
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Telephone | 816-682-3810
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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 | 2001006696
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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 | 1-12894
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License Number State | KS
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