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General NPI Number Information
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NPI Number | 1023249794
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Entity Type | Organization
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Legal Business Name | RANDAL RIVERSIDE CORPORATION
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 3360 MATLOCK RD STE 100
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City | ARLINGTON
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State | TX
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Zip | 76015-2907
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Country | US
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Telephone | 817-557-3900
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Fax | 817-557-3903
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Provider Business Mailing Address
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Address Line | 3360 MATLOCK RD STE 100
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City | ARLINGTON
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State | TX
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Zip | 76015-2907
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Country | US
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Telephone | 817-557-3900
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Fax | 817-557-3903
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | PRAFUL D PATEL
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Credential | PHARMACIST
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Telephone | 214-457-5571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26572
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License Number State | TX
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