Provider Demographics
NPI:1205164910
Name:THURMOND, RANDY N II
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:N
Last Name:THURMOND
Suffix:II
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 1:2710 SHEPHERDS GLN
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-5268
Mailing Address - Country:US
Mailing Address - Phone:940-642-6247
Mailing Address - Fax:
Practice Address - Street 1:1013 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5006
Practice Address - Country:US
Practice Address - Phone:940-723-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist