Provider Demographics
NPI:1396014155
Name:WOOTSON, RANDNETTA N (RPH)
Entity Type:Individual
Prefix:
First Name:RANDNETTA
Middle Name:N
Last Name:WOOTSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N MERIDIAN RD APT 307
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4956
Mailing Address - Country:US
Mailing Address - Phone:215-435-2665
Mailing Address - Fax:
Practice Address - Street 1:6680 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3836
Practice Address - Country:US
Practice Address - Phone:850-907-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist