Provider Demographics
NPI:1760591747
Name:CARR, RANDY S (RPH)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:S
Last Name:CARR
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 1:457 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7033
Mailing Address - Country:US
Mailing Address - Phone:524-367-5724
Mailing Address - Fax:
Practice Address - Street 1:3500 HOLIDAY DRIVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-3428
Practice Address - Country:US
Practice Address - Phone:504-367-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist