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General NPI Number Information
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NPI Number | 1750291662
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Entity Type | Individual
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Provider Name | JONATHAN MCSHANE CLINICAL PHARMACIST
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Gender |
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Dates
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Enumeration Date | 09/11/2026
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Last Update Date | 09/11/2026
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Provider Practice Location Address
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Address Line | 301 FISHER ST
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City | BILOXI
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State | MS
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Zip | 39534-2508
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Country | US
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Telephone | 228-377-9240
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Fax |
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Provider Business Mailing Address
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Address Line | 14296 SAYBROOK PL
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City | GULFPORT
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State | MS
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Zip | 39503-4133
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Country | US
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Telephone | 228-563-4937
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | E-13107
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License Number State | MS
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