Provider Demographics
NPI:1609187988
Name:OVERTON, RANDALL K (RPH)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:K
Last Name:OVERTON
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 1:1228 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4008
Mailing Address - Country:US
Mailing Address - Phone:706-861-7284
Mailing Address - Fax:706-861-7836
Practice Address - Street 1:1228 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4008
Practice Address - Country:US
Practice Address - Phone:706-861-7284
Practice Address - Fax:706-861-7836
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist