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General NPI Number Information
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NPI Number | 1679436703
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Entity Type | Organization
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Legal Business Name | MISSION TRAVIS MERCY
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 775 WEST BOWIE ST
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City | FORT WORTH
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State | TX
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Zip | 76110
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Country | US
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Telephone | 817-840-3501
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11557
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City | FORT WORTH
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State | TX
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Zip | 76110-0557
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | CELESTE COKER
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Credential | PHARM.D.
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Telephone | 817-840-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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