Healthcare Provider Details

I. General information

NPI: 1043149826
Provider Name (Legal Business Name): RANDALL PATRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E STATE ST
ATHENS OH
45701-2117
US

IV. Provider business mailing address

2445 STATE ROUTE 7 N
GALLIPOLIS OH
45631-9474
US

V. Phone/Fax

Practice location:
  • Phone: 740-566-4180
  • Fax: 740-566-4181
Mailing address:
  • Phone: 740-612-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03217941
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: