Provider Demographics
NPI:1619570215
Name:ADAMS, RANDALL (RPH)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:ADAMS
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 1:11938 LINDQUIST RD
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-8313
Mailing Address - Country:US
Mailing Address - Phone:218-440-1118
Mailing Address - Fax:
Practice Address - Street 1:11938 LINDQUIST RD
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-8313
Practice Address - Country:US
Practice Address - Phone:218-262-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist