Provider Demographics
NPI:1750426672
Name:SMITH, RANDALL C (RPH)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SIDNEY DR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-6372
Mailing Address - Country:US
Mailing Address - Phone:770-228-6799
Mailing Address - Fax:
Practice Address - Street 1:3798 HIGHWAY 42
Practice Address - Street 2:SOUTH
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3632
Practice Address - Country:US
Practice Address - Phone:770-957-6004
Practice Address - Fax:770-914-0961
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist