Provider Demographics
NPI:1851577530
Name:RANDAZZO, THOMAS ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:RANDAZZO
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 1:310 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-8150
Mailing Address - Country:US
Mailing Address - Phone:646-434-4344
Mailing Address - Fax:646-434-4345
Practice Address - Street 1:8432 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1920
Practice Address - Country:US
Practice Address - Phone:718-277-5814
Practice Address - Fax:718-277-7599
Is Sole Proprietor?:No
Enumeration Date:2008-01-13
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist