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NPI Code Detail

MEDICARE: RANDALLS FOOD & DRUGS LP

MEDICARE: RANDALLS FOOD & DRUGS LP
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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy22082TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14515803OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427087485
Entity Type Code : Organization
Provider Name (Legal Business Name) : RANDALLS FOOD & DRUGS LP
Provider Business Mailing Address
First Line : 250 E PARKCENTER BLVD
Second Line :
City : BOISE
State : ID
Zip : 83706-3940
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 TROPHY LAKE DR
Second Line :
City : TROPHY CLUB
State : TX
Zip : 76262-5233
Country : US
Telephone Number : 817-490-6968
Fax Number : 817-490-6985
Authorized Official
Title or Position : ASSISTANT MANAGER, ENROLLMENTS
Name : TIFFANY ELIOPULOS
Credential :
Telephone Number : 208-395-3906
Provider Enumeration Date : 07/02/2006
Last Update Date : 11/01/2018

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Directions to “RANDALLS FOOD & DRUGS LP ” Practice Location

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