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General NPI Number Information
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NPI Number | 1992621668
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Entity Type | Organization
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Legal Business Name | MODOC FAMILY PHARMACY INC
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Dates
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Enumeration Date | 06/26/2026
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 9340 DESCHUTES RD
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City | PALO CEDRO
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State | CA
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Zip | 96073-9763
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Country | US
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Telephone | 530-233-3113
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Fax | 530-233-3140
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Provider Business Mailing Address
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Address Line | PO BOX B
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City | ILWACO
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State | WA
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Zip | 98624-0167
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY SHANE HARRELL
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Credential |
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Telephone | 360-859-8659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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