Provider Demographics
NPI:1629145941
Name:RANDYS FAMILY DRUG & GIFT INC
Entity Type:Organization
Organization Name:RANDYS FAMILY DRUG & GIFT INC
Other - Org Name:RANDYS FAMILY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMBRUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:507-794-3631
Mailing Address - Street 1:121 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:SLEEPY EYE
Mailing Address - State:MN
Mailing Address - Zip Code:56085-1364
Mailing Address - Country:US
Mailing Address - Phone:507-794-3631
Mailing Address - Fax:507-794-7818
Practice Address - Street 1:121 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SLEEPY EYE
Practice Address - State:MN
Practice Address - Zip Code:56085-1364
Practice Address - Country:US
Practice Address - Phone:507-794-3631
Practice Address - Fax:507-794-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MN2604573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2046524OtherPK
0180220001Medicare NSC
2418069OtherNCPDP PROVIDER IDENTIFICATION NUMBER