Provider Demographics
NPI:1942483565
Name:RANDALL, NANCY J (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:RANDALL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3666 NYS ROUTE 281
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3576
Mailing Address - Country:US
Mailing Address - Phone:607-753-9359
Mailing Address - Fax:607-758-9569
Practice Address - Street 1:3666 NYS ROUTE 281
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3576
Practice Address - Country:US
Practice Address - Phone:607-753-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040647183500000X
NYI040647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist