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General NPI Number Information
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NPI Number | 1619455342
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Entity Type | Individual
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Provider Name | TIFFANY ALYSSA MEAD PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 8000 MADISON BLVD
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City | MADISON
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State | AL
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Zip | 35758-2031
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Country | US
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Telephone | 256-461-6467
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 GRANDEVIEW BLVD APT 2212
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City | HUNTSVILLE
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State | AL
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Zip | 35824-2415
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Country | US
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Telephone | 256-412-3186
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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 | 20534
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License Number State | AL
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