Provider Demographics
NPI:1629432547
Name:SHOTT, RANDY WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:WILLIAM
Last Name:SHOTT
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 1:1901 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4720
Mailing Address - Country:US
Mailing Address - Phone:215-336-5553
Mailing Address - Fax:
Practice Address - Street 1:1901 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4720
Practice Address - Country:US
Practice Address - Phone:215-336-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030828L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist