MEDICARE: RANDOLPH LEE POWELL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	09906	NC

General Provider Information

NPI Number	:	1285929422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDOLPH LEE POWELL RPH

Provider Business Mailing Address
First Line	:	9531 SOUTH BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-6901
Country	:	US
Telephone Number	:	704-553-2903
Fax Number	:	704-553-2903

Provider Business Practice Location Address
First Line	:	9531 SOUTH BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-6901
Country	:	US
Telephone Number	:	704-553-2903
Fax Number	:	704-553-2903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	06/16/2011

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