Provider Demographics
NPI:1477133528
Name:RUSH, RANDY MICHEAL (RPH)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:MICHEAL
Last Name:RUSH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 STENGAL LOOP UNIT 301
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-4415
Mailing Address - Country:US
Mailing Address - Phone:813-447-6159
Mailing Address - Fax:
Practice Address - Street 1:1929 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9202
Practice Address - Country:US
Practice Address - Phone:813-991-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist