Provider Demographics
NPI:1023400199
Name:BARBER, RANDALL
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:BARBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3042
Mailing Address - Country:US
Mailing Address - Phone:239-731-1119
Mailing Address - Fax:239-731-1330
Practice Address - Street 1:5690 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3042
Practice Address - Country:US
Practice Address - Phone:239-731-1119
Practice Address - Fax:239-731-1330
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist