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General NPI Number Information
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NPI Number | 1588656490
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Entity Type | Individual
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Provider Name | MARK STEPHEN MCCUISTON PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1110 GULF BREEZE PKWY SUITE 200 MOB
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City | GULF BREEZE
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State | FL
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Zip | 32561-4884
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Country | US
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Telephone | 850-934-2170
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Fax | 850-934-2039
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Provider Business Mailing Address
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Address Line | 751 PENSACOLA BEACH BLVD 12B
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City | PENSACOLA BEACH
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State | FL
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Zip | 32561-2079
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Country | US
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Telephone | 850-932-5152
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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 | PS31721
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License Number State | FL
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