Provider Demographics
NPI:1952887473
Name:RALPH, RANDON (PHARMD)
Entity Type:Individual
Prefix:
First Name:RANDON
Middle Name:
Last Name:RALPH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 FRESHLY BREWED CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4811
Mailing Address - Country:US
Mailing Address - Phone:702-333-5573
Mailing Address - Fax:
Practice Address - Street 1:10250 W.CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135
Practice Address - Country:US
Practice Address - Phone:702-838-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist