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General NPI Number Information
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NPI Number | 1700392990
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Entity Type | Individual
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Provider Name | JENNIFER LYNN RATLIFF
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Gender | Female
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/21/2018
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Provider Practice Location Address
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Address Line | 901 E SOUTHWIND RD
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City | SPRINGFIELD
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State | IL
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Zip | 62703-5125
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Country | US
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Telephone | 217-786-6930
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Fax | 217-786-0225
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Provider Business Mailing Address
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Address Line | 40 TIMBERLINE LN
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City | SHERMAN
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State | IL
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Zip | 62684-9726
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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 |
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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 | 051-286018
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License Number State | IL
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