Provider Demographics
NPI:1992826499
Name:RANDALL, JANIS (RPH)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
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 1:3240 EDWARDS LAKE PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3117
Mailing Address - Country:US
Mailing Address - Phone:205-661-2633
Mailing Address - Fax:205-661-2763
Practice Address - Street 1:3240 EDWARDS LAKE PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3117
Practice Address - Country:US
Practice Address - Phone:205-661-2633
Practice Address - Fax:205-661-2329
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist