MEDICARE: MR. ROBERT RANDAL WARNOCK R.PH

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	1835G0303X	Geriatric Pharmacist	12648	GA

General Provider Information

NPI Number	:	1982989026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT RANDAL WARNOCK R.PH

Provider Business Mailing Address
First Line	:	1060 RIVERHILL DR
Second Line	:
City	:	BISHOP
State	:	GA
Zip	:	30621-6121
Country	:	US
Telephone Number	:	770-880-6901
Fax Number	:	479-478-2459

Provider Business Practice Location Address
First Line	:	1060 RIVERHILL DR
Second Line	:
City	:	BISHOP
State	:	GA
Zip	:	30621-6121
Country	:	US
Telephone Number	:	770-880-6901
Fax Number	:	479-478-2459

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

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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