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General NPI Number Information
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NPI Number | 1841020229
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Entity Type | Individual
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Provider Name | LOGAN SANDERSON
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Gender | Male
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Dates
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Enumeration Date | 08/01/2024
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 6201 STELLHORN RD
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City | FORT WAYNE
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State | IN
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Zip | 46815-5349
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Country | US
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Telephone | 260-485-0755
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Fax |
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Provider Business Mailing Address
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Address Line | 214 E EDGERTON ST
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City | HICKSVILLE
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State | OH
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Zip | 43526-1407
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Country | US
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Telephone | 419-487-3991
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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 | 45024079A
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License Number State | IN
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