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General NPI Number Information
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NPI Number | 1992705339
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Entity Type | Organization
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Legal Business Name | RANDY'S GATEWAY DRUG, INC
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 08/31/2024
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Provider Practice Location Address
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Address Line | 3118 CEDAR VALLEY DR
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City | RICHLANDS
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State | VA
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Zip | 24641-3075
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Country | US
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Telephone | 276-964-2494
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Fax | 276-963-2920
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Provider Business Mailing Address
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Address Line | 3118 CEDAR VALLEY DR
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City | RICHLANDS
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State | VA
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Zip | 24641-3075
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Country | US
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Telephone | 276-964-2494
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Fax | 276-963-2920
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Authorized Official
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Title or Position | PHARMACIST/PRESIDENT
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Name | JAMES H GIBSON
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Credential | RPH
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Telephone | 276-964-2494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0201003219
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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