Provider Demographics
NPI:1275843294
Name:OWERS, RANDY WAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:WAYNE
Last Name:OWERS
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:PO BOX 1072
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-1072
Mailing Address - Country:US
Mailing Address - Phone:318-235-3847
Mailing Address - Fax:
Practice Address - Street 1:604 BELUE LN
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3870
Practice Address - Country:US
Practice Address - Phone:318-251-6385
Practice Address - Fax:318-255-7530
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist