Provider Demographics
NPI:1114019601
Name:LINDVALL, RANDALL L (RPH)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:L
Last Name:LINDVALL
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 1:501 SW WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4620
Mailing Address - Country:US
Mailing Address - Phone:816-616-9182
Mailing Address - Fax:
Practice Address - Street 1:2323 E 63RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-3462
Practice Address - Country:US
Practice Address - Phone:816-234-8121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9786183500000X
MO0409121835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
No183500000XPharmacy Service ProvidersPharmacist