Provider Demographics
NPI:1558405001
Name:HEDRICK, RANDALL SHANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:SHANE
Last Name:HEDRICK
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 1:6402 ROSNY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3111
Mailing Address - Country:US
Mailing Address - Phone:919-618-3631
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:DEPT. OF PHARMACY
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-9843
Practice Address - Fax:919-966-0243
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist