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General NPI Number Information
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NPI Number | 1992282198
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Entity Type | Individual
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Provider Name | HARVEY L ROTH RPH
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Gender | Male
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 252 W SR 434
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City | LONGWOOD
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State | FL
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Zip | 32750-5114
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Country | US
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Telephone | 407-332-9753
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Fax | 407-332-9704
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Provider Business Mailing Address
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Address Line | 870 LAKEWORTH CIR
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City | LAKE MARY
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State | FL
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Zip | 32746-5351
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Country | US
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Telephone | 407-754-4196
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Fax | 407-332-9704
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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 | PS20712
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License Number State | FL
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