Provider Demographics
NPI:1346572989
Name:RANDALL, CHRISTINE MARIE (MS RPH BCGP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MS RPH BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 BURGESS HILL DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4092
Mailing Address - Country:US
Mailing Address - Phone:585-755-7718
Mailing Address - Fax:
Practice Address - Street 1:841 PRUDENTIAL DR STE 180
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8350
Practice Address - Country:US
Practice Address - Phone:904-202-4613
Practice Address - Fax:904-202-4638
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041426183500000X
FLPS634411835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacist