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General NPI Number Information
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NPI Number | 1538690169
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Entity Type | Individual
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Provider Name | MR. PRADEEPKUMAR R PATEL
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Gender | Male
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 300-G PULLMAN STREET
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City | LIVERMORE
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State | CA
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Zip | 94551
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Country | US
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Telephone | 925-294-9667
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Fax |
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Provider Business Mailing Address
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Address Line | 5414 BROOK HOLLOW CT
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City | STOCKTON
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State | CA
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Zip | 95219-2440
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Country | US
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Telephone | 209-810-2619
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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 | 42297
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License Number State | CA
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