Healthcare Provider Details

I. General information

NPI: 1235127366
Provider Name (Legal Business Name): RANDY'S HELEN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8016 S MAIN ST SUITE A-1
HELEN GA
30545-3620
US

IV. Provider business mailing address

PO BOX 339
HELEN GA
30545-0339
US

V. Phone/Fax

Practice location:
  • Phone: 706-878-0066
  • Fax: 706-878-1426
Mailing address:
  • Phone: 706-878-0066
  • Fax: 706-878-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE 008830
License Number StateGA

VIII. Authorized Official

Name: MR. RANDALL T ROGUS
Title or Position: PHARMACIST
Credential: R.PH.
Phone: 706-878-0066