Provider Demographics
NPI:1336744200
Name:DUMORNAY, RANDY (RPH)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:DUMORNAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:DUMORNAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:11458 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-4200
Mailing Address - Country:US
Mailing Address - Phone:540-775-2284
Mailing Address - Fax:
Practice Address - Street 1:11458 KINGS HWY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-4200
Practice Address - Country:US
Practice Address - Phone:540-775-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist