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General NPI Number Information
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NPI Number | 1720672421
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Entity Type | Organization
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Legal Business Name | CENTRALIA PHARMACY GROUP, INC.
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 417 S TOWER AVE
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City | CENTRALIA
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State | WA
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Zip | 98531-3917
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Country | US
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Telephone | 360-736-5000
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Fax | 360-736-9433
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Provider Business Mailing Address
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Address Line | PO BOX B
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City | ILWACO
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State | WA
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Zip | 98624-0167
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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 | OWNER
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Name | JEFFREY SHANE HARRELL
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Credential | PHARMD
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Telephone | 360-244-5984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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