Provider Demographics
NPI:1023249794
Name:RANDAL RIVERSIDE CORPORATION
Entity type:Organization
Organization Name:RANDAL RIVERSIDE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:PRAFUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:214-457-5571
Mailing Address - Street 1:3360 MATLOCK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2907
Mailing Address - Country:US
Mailing Address - Phone:817-557-3900
Mailing Address - Fax:817-557-3903
Practice Address - Street 1:3360 MATLOCK RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2907
Practice Address - Country:US
Practice Address - Phone:817-557-3900
Practice Address - Fax:817-557-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy