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General NPI Number Information
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NPI Number | 1871963587
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Entity Type | Individual
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Provider Name | WILLIAM CHARLES MAIDEN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 16980 ALICO MISSION WAY STE 403
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City | FORT MYERS
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State | FL
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Zip | 33908-4851
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Country | US
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Telephone | 239-489-0729
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Fax | 239-489-3496
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Provider Business Mailing Address
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Address Line | 16980 ALICO MISSION WAY UNIT 403
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City | FORT MYERS
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State | FL
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Zip | 33908-4851
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Country | US
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Telephone | 304-266-8895
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Fax | 239-489-3496
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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 | PS53863
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License Number State | FL
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