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General NPI Number Information
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NPI Number | 1659444297
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Entity Type | Organization
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Legal Business Name | MICRIMAR INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 221 S BROADWAY
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City | CAMDEN
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State | NJ
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Zip | 08103-1287
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Country | US
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Telephone | 856-365-3400
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Fax | 610-668-1077
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Provider Business Mailing Address
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Address Line | 730 BRYN MAWR AVE
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City | NARBERTH
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State | PA
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Zip | 19072-1402
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Country | US
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Telephone | 856-365-3400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL VIOLA
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Credential | RPH
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Telephone | 856-365-3400
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RS00288000
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License Number State | NJ
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