Provider Demographics
NPI:1336390368
Name:RANDOLPH, HELEN ASBERRY (PHAMD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:ASBERRY
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2136
Mailing Address - Country:US
Mailing Address - Phone:773-434-7186
Mailing Address - Fax:773-778-7585
Practice Address - Street 1:2751 W 51ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2136
Practice Address - Country:US
Practice Address - Phone:773-434-7186
Practice Address - Fax:773-778-7585
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510373551835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist