Provider Demographics
NPI:1518117936
Name:SARLES, RANDOLPH MARC (RPH)
Entity Type:Individual
Prefix:MR
First Name:RANDOLPH
Middle Name:MARC
Last Name:SARLES
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 1:205 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2514
Mailing Address - Country:US
Mailing Address - Phone:304-887-6632
Mailing Address - Fax:
Practice Address - Street 1:205 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2514
Practice Address - Country:US
Practice Address - Phone:304-887-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist