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General NPI Number Information
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NPI Number | 1851627657
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Entity Type | Individual
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Provider Name | MICHAEL J ILARDO RPH
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Gender | Male
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 1234 ABBOTT RD SUITE #210
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City | LACKAWANNA
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State | NY
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Zip | 14218-1944
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Country | US
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Telephone | 716-768-2500
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Fax | 716-768-3355
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Provider Business Mailing Address
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Address Line | 10419 PINE ST
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City | NORTH COLLINS
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State | NY
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Zip | 14111-9405
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Country | US
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Telephone | 716-337-2530
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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 | 048141
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License Number State | NY
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