Provider Demographics
NPI:1710417175
Name:NULPH, RANDIE
Entity Type:Individual
Prefix:MR
First Name:RANDIE
Middle Name:
Last Name:NULPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:PA
Mailing Address - Zip Code:16232-2909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:431 COMMONS DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3815
Practice Address - Country:US
Practice Address - Phone:814-371-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042583L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist