Provider Demographics
NPI:1093945289
Name:SMITH, RANDALL JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:JAMES
Last Name:SMITH
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 1:64 CONGRESS ST
Mailing Address - Street 2:INK PLAZA &THE OTHER PHARMACY
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2003
Mailing Address - Country:US
Mailing Address - Phone:207-992-6705
Mailing Address - Fax:
Practice Address - Street 1:64 CONGRESS ST
Practice Address - Street 2:INK PLAZA &THE OTHER PHARMACY
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2003
Practice Address - Country:US
Practice Address - Phone:207-992-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist