Provider Demographics
NPI:1063010569
Name:GETTIS, RANDY (RPH)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:GETTIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:MN
Mailing Address - Zip Code:56098-1042
Mailing Address - Country:US
Mailing Address - Phone:507-236-2379
Mailing Address - Fax:
Practice Address - Street 1:1250 GOEMANN RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4659
Practice Address - Country:US
Practice Address - Phone:507-235-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist