Provider Demographics
NPI:1851843445
Name:HABECKER, RANDY (RPH)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:HABECKER
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 1:545 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5320
Mailing Address - Country:US
Mailing Address - Phone:717-272-2261
Mailing Address - Fax:717-272-2275
Practice Address - Street 1:545 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5320
Practice Address - Country:US
Practice Address - Phone:717-272-2261
Practice Address - Fax:717-272-2275
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-032331-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist