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General NPI Number Information
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NPI Number | 1942664669
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Entity Type | Individual
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Provider Name | STACEY K SMITH RPH
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Gender | Female
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 1787 ALLENDALE FAIRFAX HWY
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City | FAIRFAX
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State | SC
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Zip | 29827-9133
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Country | US
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Telephone | 803-702-4279
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Fax | 803-632-8164
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Provider Business Mailing Address
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Address Line | 330 HAMMOND DR
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City | ALLENDALE
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State | SC
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Zip | 29810-2122
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Country | US
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Telephone | 803-584-0823
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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 | 8721
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License Number State | SC
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