Provider Demographics
NPI:1538513346
Name:RANDLEMAN PLAZA PHARMACY
Entity Type:Organization
Organization Name:RANDLEMAN PLAZA PHARMACY
Other - Org Name:RANDLEMAN PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-263-0603
Mailing Address - Street 1:3230 RANDLEMAN RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6566
Mailing Address - Country:US
Mailing Address - Phone:336-763-6878
Mailing Address - Fax:336-763-2789
Practice Address - Street 1:3230 RANDLEMAN RD STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-6566
Practice Address - Country:US
Practice Address - Phone:336-763-6878
Practice Address - Fax:336-763-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC129543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160039OtherPK