MEDICARE: MR. RANDY KENT PAIR RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PH000010583	WA

General Provider Information

NPI Number	:	1326442609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY KENT PAIR RPH

Provider Business Mailing Address
First Line	:	1313 COOPER POINT RD SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5729
Country	:	US
Telephone Number	:	360-754-1504
Fax Number	:	360-754-1782

Provider Business Practice Location Address
First Line	:	1313 COOPER POINT RD SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5729
Country	:	US
Telephone Number	:	360-754-1504
Fax Number	:	360-754-1782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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