Provider Demographics
NPI:1639191174
Name:WRIGHT, RANDY C (RPH)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:C
Last Name:WRIGHT
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:CLAUDE
Mailing Address - State:TX
Mailing Address - Zip Code:79019-0129
Mailing Address - Country:US
Mailing Address - Phone:806-226-2221
Mailing Address - Fax:806-226-2309
Practice Address - Street 1:200 PARKS STREET
Practice Address - Street 2:
Practice Address - City:CLAUDE
Practice Address - State:TX
Practice Address - Zip Code:79019
Practice Address - Country:US
Practice Address - Phone:806-226-2221
Practice Address - Fax:806-226-2309
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22397OtherPHARMACIST CERTIFICATE