Provider Demographics
NPI:1205178316
Name:BANIK, RANDAL ROBERT
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:ROBERT
Last Name:BANIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E WHITESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6902
Mailing Address - Country:US
Mailing Address - Phone:512-259-5755
Mailing Address - Fax:
Practice Address - Street 1:170 E WHITESTONE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6902
Practice Address - Country:US
Practice Address - Phone:512-259-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist