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General NPI Number Information
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NPI Number | 1639897085
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Entity Type | Organization
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Legal Business Name | WOODSIDE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1551 STURDY RD
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City | VALPARAISO
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State | IN
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Zip | 46383-7883
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Country | US
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Telephone | 219-286-3091
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Fax | 219-510-5268
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Provider Business Mailing Address
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Address Line | 1551 STURDY RD
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City | VALPARAISO
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State | IN
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Zip | 46383-7883
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Country | US
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Telephone | 219-286-3091
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Fax | 219-510-5268
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MOHAMED REFAAT AHMED SALEH
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Credential | PHARM.D.
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Telephone | 219-286-3091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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