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General NPI Number Information
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NPI Number | 1750931960
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Entity Type | Individual
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Provider Name | RYAN GOFF PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 113 SAINT FRANCOIS PLZ
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City | LEADINGTON
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State | MO
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Zip | 63601-4454
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Country | US
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Telephone | 573-431-5040
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Fax | 573-431-8967
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Provider Business Mailing Address
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Address Line | 8 LARKSPUR DR
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City | NEW BADEN
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State | IL
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Zip | 62265-2205
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Country | US
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Telephone | 618-409-7431
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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 | 2019033482
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License Number State | MO
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