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General NPI Number Information
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NPI Number | 1710550082
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Entity Type | Individual
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Provider Name | MYCHAL VINCENT DENTON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 7838 GALL BLVD
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-4302
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Country | US
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Telephone | 813-715-4184
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Fax |
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Provider Business Mailing Address
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Address Line | 36431 SHADY LN
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City | DADE CITY
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State | FL
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Zip | 33525-8319
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Country | US
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Telephone | 352-467-1491
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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 | PS62718
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License Number State | FL
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