Provider Demographics
NPI:1255332052
Name:MCDONOUGH, RANDY PATRICK (PHARMD, MS, BCPS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:PATRICK
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:PHARMD, MS, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 MUSCATINE AVE
Mailing Address - Street 2:TOWNCREST PHARMACY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6637
Mailing Address - Country:US
Mailing Address - Phone:319-337-3526
Mailing Address - Fax:319-337-5271
Practice Address - Street 1:2306 MUSCATINE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6637
Practice Address - Country:US
Practice Address - Phone:319-337-3526
Practice Address - Fax:319-337-5271
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA169181835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0006585Medicaid