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General NPI Number Information
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NPI Number | 1801933882
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Entity Type | Individual
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Provider Name | KATHLEEN T WADE RPH, PHARM D, PHC
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 8300 CONSTITUTION PL NE RM 1132
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7637
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Country | US
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Telephone | 505-291-2402
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Fax | 505-291-2546
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Provider Business Mailing Address
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Address Line | PO BOX 206
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City | CEDAR CREST
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State | NM
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Zip | 87008-0206
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Country | US
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Telephone | 505-281-5720
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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 | RP00004892
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License Number State | NM
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Taxonomy #2
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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 | 4892
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License Number State | NM
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