Provider Demographics
NPI:1982194221
Name:LAHTI, RANDALL WILLIAM (RPH)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:WILLIAM
Last Name:LAHTI
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 1:116 SOUTHFIELDS RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-3206
Mailing Address - Country:US
Mailing Address - Phone:850-855-7551
Mailing Address - Fax:800-373-0108
Practice Address - Street 1:2605 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2339
Practice Address - Country:US
Practice Address - Phone:800-763-2671
Practice Address - Fax:800-373-0108
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist