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General NPI Number Information
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NPI Number | 1780781625
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Entity Type | Organization
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Legal Business Name | MEDFORD PHARMACY GROUP LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 2355 W MAIN ST
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City | MEDFORD
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State | OR
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Zip | 97501
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Country | US
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Telephone | 541-772-2330
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Fax | 541-772-4852
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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
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Country | US
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Telephone | 360-642-3133
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Fax | 360-642-5133
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY S HARRELL
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Credential | PHARM D
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP0000291CS
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License Number State | OR
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