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General NPI Number Information
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NPI Number | 1972627826
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Entity Type | Individual
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Provider Name | MICHAEL A POLISE RPH
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Gender | Male
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Dates
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Enumeration Date | 03/18/2007
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 2392 21ST ST
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City | ASTORIA
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State | NY
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Zip | 11105
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Country | US
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Telephone | 718-728-3300
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Fax | 718-728-3305
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Provider Business Mailing Address
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Address Line | 2253 CRESCENT ST
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City | ASTORIA
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State | NY
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Zip | 11105-3105
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Country | US
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Telephone | 917-496-4013
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Fax | 718-728-3305
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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 | 049925
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License Number State | NY
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