Provider Demographics
NPI:1013219997
Name:BALL, RANDY GRAY (R PH)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:GRAY
Last Name:BALL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2719
Mailing Address - Country:US
Mailing Address - Phone:919-556-1900
Mailing Address - Fax:919-556-1791
Practice Address - Street 1:245 E ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2719
Practice Address - Country:US
Practice Address - Phone:919-556-1900
Practice Address - Fax:919-556-1791
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-25
Last Update Date:2010-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist