Provider Demographics
NPI:1205162146
Name:RANDOLPH, SARAH (PHARMD RPH)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 W 275 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-9139
Mailing Address - Country:US
Mailing Address - Phone:260-327-3820
Mailing Address - Fax:
Practice Address - Street 1:1 EXPRESS WAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-1824
Practice Address - Country:US
Practice Address - Phone:260-327-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0150291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist