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General NPI Number Information
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NPI Number | 1801127931
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Entity Type | Individual
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Provider Name | STEPHEN VINCENT MIRO RPH
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Gender | Male
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 750 MIDDLE COUNTRY RD
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City | MIDDLE ISLAND
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State | NY
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Zip | 11953-2542
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Country | US
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Telephone | 631-924-0154
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Fax |
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Provider Business Mailing Address
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Address Line | 27 JEFFERSON ST
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City | NESCONSET
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State | NY
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Zip | 11767-2911
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Country | US
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Telephone | 631-588-9454
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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 | 035810
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License Number State | NY
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