Provider Demographics
NPI:1801989850
Name:RANDALL PHARMACY INC
Entity type:Organization
Organization Name:RANDALL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-827-4114
Mailing Address - Street 1:582 SOUTH OHIO STREET
Mailing Address - Street 2:
Mailing Address - City:SACINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-827-4114
Mailing Address - Fax:785-827-2144
Practice Address - Street 1:582 S OHIO STREET
Practice Address - Street 2:
Practice Address - City:SACINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-827-4114
Practice Address - Fax:785-827-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2095273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1711161OtherNCPDP #
209527OtherSTATE KANSAS LICENSE
209527OtherSTATE KANSAS LICENSE