Provider Demographics
NPI:1437705027
Name:SMITH, RANDI DA'LESE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:DA'LESE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6237
Mailing Address - Country:US
Mailing Address - Phone:806-570-5837
Mailing Address - Fax:
Practice Address - Street 1:3400 RIVER RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-1800
Practice Address - Country:US
Practice Address - Phone:806-383-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist