Provider Demographics
NPI:1710750088
Name:RANDOLPH PHARMACY LTC
Entity Type:Organization
Organization Name:RANDOLPH PHARMACY LTC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRIET
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-885-1181
Mailing Address - Street 1:1187 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2135
Mailing Address - Country:US
Mailing Address - Phone:781-885-1181
Mailing Address - Fax:781-885-1284
Practice Address - Street 1:1187 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2135
Practice Address - Country:US
Practice Address - Phone:781-885-1181
Practice Address - Fax:781-885-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy