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Individual
DERK PENROD
Active
Individual
DERK PENROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0013656
OR
183500000X
Pharmacist
120777
MN
183500000X
Pharmacist
2079
AK
Other
Enumeration date
08/27/2013
Last updated
08/27/2013
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