Provider Demographics
NPI:1376143693
Name:CULPEPPER, RANDY D (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:D
Last Name:CULPEPPER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11221 ROAD 210
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2989
Mailing Address - Country:US
Mailing Address - Phone:601-650-9429
Mailing Address - Fax:
Practice Address - Street 1:905 HIGHWAY 16 W
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4426
Practice Address - Country:US
Practice Address - Phone:601-267-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-6002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist