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General NPI Number Information
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NPI Number | 1689086381
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Entity Type | Organization
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Legal Business Name | BENTON COUNTY
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 530 NW 27TH ST
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City | CORVALLIS
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State | OR
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Zip | 97330-5223
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Country | US
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Telephone | 541-766-2400
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Fax | 541-766-0110
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Provider Business Mailing Address
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Address Line | 530 NW 27TH ST
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City | CORVALLIS
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State | OR
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Zip | 97330-5223
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Country | US
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Telephone | 541-766-6835
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Fax | 541-766-0111
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Authorized Official
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Title or Position | HEALTH DEPARTMENT DIRECTOR
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Name | LACEY MOLLEL
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Credential |
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Telephone | 541-766-6835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | RP0002882
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | RP0002882CS
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License Number State | OR
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