Provider Demographics
NPI:1497162002
Name:STOUT, RANDY LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:STOUT
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 1:2113 WELLS BRANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6970
Mailing Address - Country:US
Mailing Address - Phone:512-501-7819
Mailing Address - Fax:
Practice Address - Street 1:2113 WELLS BRANCH PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6970
Practice Address - Country:US
Practice Address - Phone:512-501-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist