Healthcare Provider Details

I. General information

NPI: 1922320571
Provider Name (Legal Business Name): EVANGELIA ZOE RANDALL PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 HOPKINS RD
WILLIAMSVILLE NY
14221-1752
US

IV. Provider business mailing address

6727 MACINTOSH LN
NORTH TONAWANDA NY
14120-9649
US

V. Phone/Fax

Practice location:
  • Phone: 716-568-0075
  • Fax:
Mailing address:
  • Phone: 716-544-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: