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General NPI Number Information
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NPI Number | 1750008504
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Entity Type | Individual
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Provider Name | MARTIN U MUFORO PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 748 BEAL PKWY NW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-3002
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Country | US
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Telephone | 850-863-2204
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 PATRIOT LN APT 228
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City | CRESTVIEW
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State | FL
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Zip | 32539-7404
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Country | US
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Telephone | 813-340-1098
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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 | PS64901
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License Number State | FL
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