Provider Demographics
NPI:1659956274
Name:KING, RANDALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1599
Mailing Address - Country:US
Mailing Address - Phone:610-521-7011
Mailing Address - Fax:
Practice Address - Street 1:1306 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1599
Practice Address - Country:US
Practice Address - Phone:610-521-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236412183500000X
PARP455361P183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist