Healthcare Provider Details

I. General information

NPI: 1275843294
Provider Name (Legal Business Name): RANDY WAYNE OWERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 BELUE LN
RUSTON LA
71270-3870
US

IV. Provider business mailing address

PO BOX 1072
RUSTON LA
71273-1072
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-6385
  • Fax: 318-255-7530
Mailing address:
  • Phone: 318-235-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18354
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: