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General NPI Number Information
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NPI Number | 1538342373
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Entity Type | Individual
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Provider Name | MR. KEVIN D. REILLY
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Gender | Male
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Dates
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Enumeration Date | 12/16/2007
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Last Update Date | 12/16/2007
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Provider Practice Location Address
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Address Line | 1792 N GOODMAN ST
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City | ROCHESTER
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State | NY
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Zip | 14609-1036
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Country | US
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Telephone | 585-467-4422
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Fax | 585-266-3057
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Provider Business Mailing Address
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Address Line | 93 BROADMOOR TRL PO BOX 231
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City | FAIRPORT
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State | NY
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Zip | 14450-9386
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Country | US
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Telephone | 585-388-0931
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Fax | 585-425-2327
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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 | 33647
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License Number State | NY
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