Provider Demographics
NPI:1912585340
Name:DEPOY, RANDY LEWIS (RPH)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LEWIS
Last Name:DEPOY
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 1:5354 RED WYNNE LN
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8954
Mailing Address - Country:US
Mailing Address - Phone:614-771-6534
Mailing Address - Fax:
Practice Address - Street 1:40 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2204
Practice Address - Country:US
Practice Address - Phone:614-227-6869
Practice Address - Fax:614-227-6872
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS007897183500000X
MST-12300183500000X
OH116073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist