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General NPI Number Information
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NPI Number | 1881295319
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Entity Type | Individual
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Provider Name | MARK CHRISTOPHER WRIGHTMAN
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Gender | Male
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 10251 SHOPS LN
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City | JACKSONVILLE
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State | FL
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Zip | 32258-7406
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Country | US
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Telephone | 904-288-8189
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Fax | 904-288-8450
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Provider Business Mailing Address
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Address Line | 1220 GARRISON DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-1075
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Country | US
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Telephone | 904-305-4715
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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 | PS22994
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License Number State | FL
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