Provider Demographics
NPI:1114264058
Name:O'NEILL, RANDALL WALTERS JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:WALTERS
Last Name:O'NEILL
Suffix:JR
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 1:3830 S HWY A1A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3143
Mailing Address - Country:US
Mailing Address - Phone:321-725-3711
Mailing Address - Fax:321-725-4435
Practice Address - Street 1:3830 S HWY A1A
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-3143
Practice Address - Country:US
Practice Address - Phone:321-725-3711
Practice Address - Fax:321-725-4435
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist