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General NPI Number Information
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NPI Number | 1912289547
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Entity Type | Organization
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Legal Business Name | MGC PHARMACY LLC
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 1516 E 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33010-3159
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Country | US
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Telephone | 305-884-7455
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Fax | 305-884-7454
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Provider Business Mailing Address
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Address Line | 1516 E 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33010-3159
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Country | US
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Telephone | 305-884-7455
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Fax | 305-884-7454
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Authorized Official
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Title or Position | CLINICAL PHARMACY DIRECTOR
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Name | DR. LUIS J ALFONSO
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Credential | PHARMD
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Telephone | 305-884-7455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH25619
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License Number State | FL
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