MEDICARE: RANDOLPH JOHN THOMPSON 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	RPH011732	GA

General Provider Information

NPI Number	:	1538393772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDOLPH JOHN THOMPSON RPH

Provider Business Mailing Address
First Line	:	379 N MAIN ST
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-1127
Country	:	US
Telephone Number	:	706-865-2525
Fax Number	:	706-219-1355

Provider Business Practice Location Address
First Line	:	379 N MAIN ST
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-1127
Country	:	US
Telephone Number	:	706-865-2525
Fax Number	:	706-219-1355

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

Provider Enumeration Date	:	05/02/2009
Last Update Date	:	05/02/2009

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