Provider Demographics
NPI:1497915458
Name:RANDALL, STEVEN L
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:RANDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16560 REATA CT
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-9459
Mailing Address - Country:US
Mailing Address - Phone:719-749-2258
Mailing Address - Fax:
Practice Address - Street 1:16560 REATA CT
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-9459
Practice Address - Country:US
Practice Address - Phone:719-749-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist