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General NPI Number Information
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NPI Number | 1548617137
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Entity Type | Organization
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Legal Business Name | SPECIALTY CARE, LLC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 4229 1ST AVE STE B
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City | TUCKER
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State | GA
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Zip | 30084-4469
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Country | US
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Telephone | 770-496-8998
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Fax |
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Provider Business Mailing Address
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Address Line | 4229 1ST AVE STE B
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City | TUCKER
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State | GA
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Zip | 30084-4469
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Country | US
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Telephone | 770-496-8998
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMIT RAVAL
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Credential |
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Telephone | 770-496-8998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE010292
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License Number State | GA
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