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General NPI Number Information
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NPI Number | 1528525250
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Entity Type | Organization
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Legal Business Name | REVUE PHARMACY
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 869 N MAIN ST STE 203
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City | ALPHARETTA
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State | GA
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Zip | 30009-8372
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Country | US
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Telephone | 470-275-6795
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Fax | 470-275-4962
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Provider Business Mailing Address
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Address Line | 869 N MAIN ST STE 203
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City | ALPHARETTA
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State | GA
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Zip | 30009-8372
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Country | US
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Telephone | 702-756-7954
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Fax | 470-275-4962
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | GICHUKI KIMANI
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Credential | PHARM.D.
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Telephone | 404-512-0517
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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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