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General NPI Number Information
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NPI Number | 1508675364
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Entity Type | Organization
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Legal Business Name | INNOMINDS LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1215 E WASHINGTON AVE
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City | UNION GAP
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State | WA
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Zip | 98903-1669
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Country | US
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Telephone | 509-823-1657
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Fax | 509-823-1658
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Provider Business Mailing Address
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Address Line | PO BOX 8201
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City | YAKIMA
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State | WA
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Zip | 98908-0201
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Country | US
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Telephone | 509-823-1657
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. MASTAN RAMPRASAD GANGISETTI
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Credential | RPH
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Telephone | 509-942-4835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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