Provider Demographics
NPI:1164407557
Name:MEENTS, RANDY KYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:KYLE
Last Name:MEENTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N. GRAND ST., SUITE 1
Mailing Address - Street 2:P.O. BOX 158
Mailing Address - City:GREENFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65661-0158
Mailing Address - Country:US
Mailing Address - Phone:417-637-2909
Mailing Address - Fax:417-637-5621
Practice Address - Street 1:105 N. GRAND ST., SUITE 1
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661-0158
Practice Address - Country:US
Practice Address - Phone:417-637-2909
Practice Address - Fax:417-637-5621
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0402941835G0303X, 183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO358397800Medicaid