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General NPI Number Information
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NPI Number | 1811623895
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Entity Type | Individual
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Provider Name | KHALI D MILLER
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Gender | Female
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 3521 NW SAMARITAN DR STE 202
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City | CORVALLIS
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State | OR
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Zip | 97330-4744
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Country | US
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Telephone | 541-768-5225
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 BAYWOOD ST
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City | EUGENE
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State | OR
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Zip | 97404-1411
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Country | US
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Telephone | 503-798-3482
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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 | RPH-0019049
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License Number State | OR
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