Provider Demographics
NPI:1417274705
Name:NIEMEYER, RANDY JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JAMES
Last Name:NIEMEYER
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 1:200 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691-1207
Mailing Address - Country:US
Mailing Address - Phone:254-826-5122
Mailing Address - Fax:254-826-3768
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691-1207
Practice Address - Country:US
Practice Address - Phone:254-826-5122
Practice Address - Fax:254-826-3768
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142315Medicaid