Provider Demographics
NPI:1114047396
Name:SHOPE, RANDALL R (RPH, MBA)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:R
Last Name:SHOPE
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 QUEEN ANNE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-9228
Mailing Address - Country:US
Mailing Address - Phone:814-696-4128
Mailing Address - Fax:814-949-4274
Practice Address - Street 1:2621 8TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2044
Practice Address - Country:US
Practice Address - Phone:814-949-4272
Practice Address - Fax:814-949-4274
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031336L1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric