Provider Demographics
NPI:1508910134
Name:MYERS, RANDALL S (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:S
Last Name:MYERS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E FINDLAY ST
Mailing Address - Street 2:
Mailing Address - City:CAREY
Mailing Address - State:OH
Mailing Address - Zip Code:43316-1247
Mailing Address - Country:US
Mailing Address - Phone:419-396-7977
Mailing Address - Fax:419-396-6292
Practice Address - Street 1:101 E FINDLAY ST
Practice Address - Street 2:
Practice Address - City:CAREY
Practice Address - State:OH
Practice Address - Zip Code:43316-1247
Practice Address - Country:US
Practice Address - Phone:419-396-7977
Practice Address - Fax:419-396-6292
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-14538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist