Provider Demographics
NPI:1194001206
Name:FELDMAN, RANDY (RPH)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:FELDMAN
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 1:14436 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3701
Mailing Address - Country:US
Mailing Address - Phone:952-933-8409
Mailing Address - Fax:
Practice Address - Street 1:14436 DURHAM RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3701
Practice Address - Country:US
Practice Address - Phone:952-933-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113401183500000X
WI9957040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist