Healthcare Provider Details

I. General information

NPI: 1629145941
Provider Name (Legal Business Name): RANDYS FAMILY DRUG & GIFT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 1ST AVE S
SLEEPY EYE MN
56085-1364
US

IV. Provider business mailing address

121 1ST AVE S
SLEEPY EYE MN
56085-1364
US

V. Phone/Fax

Practice location:
  • Phone: 507-794-3631
  • Fax: 507-794-7818
Mailing address:
  • Phone: 507-794-3631
  • Fax: 507-794-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number260457
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RANDALL ARMBRUSTER
Title or Position: OWNER
Credential: B.S.
Phone: 507-794-3631