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General NPI Number Information
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NPI Number | 1720415599
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Entity Type | Organization
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Legal Business Name | VILLA PHARMACY LLC
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 105 AVENUE R NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881
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Country | US
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Telephone | 813-215-9855
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Fax |
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Provider Business Mailing Address
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Address Line | 105 AVENUE R NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-2147
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Country | US
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Telephone | 813-215-9855
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. DWAYNE JONES SR.
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Credential | PHARMD
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Telephone | 813-215-9855
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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 | PH27110
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License Number State | FL
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