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General NPI Number Information
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NPI Number | 1558760538
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Entity Type | Individual
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Provider Name | GRANT CALLOWAY PORTER PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 7845 WISE AVE
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City | DUNDALK
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State | MD
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Zip | 21222-3339
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Country | US
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Telephone | 410-285-1401
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Fax |
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Provider Business Mailing Address
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Address Line | 904 LIGHT ST APT D
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City | BALTIMORE
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State | MD
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Zip | 21230-4063
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Country | US
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Telephone | 973-271-9830
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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 | 21751
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP448193
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License Number State | PA
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