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General NPI Number Information
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NPI Number | 1811201874
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Entity Type | Individual
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Provider Name | JESSICA STORCK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 515 22ND AVE PHARMACY DEPARTMENT
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City | MONROE
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State | WI
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Zip | 53566-1569
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Country | US
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Telephone | 608-324-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 242 W CHURCH ST
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City | BELLEVILLE
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State | WI
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Zip | 53508-9332
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Country | US
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Telephone | 608-469-7430
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 15668-40
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License Number State | WI
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