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NPI Code Detail

MEDICARE: RANDALLS FOOD & DRUGS LP

MEDICARE: RANDALLS FOOD & DRUGS LP
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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy22088TX
33336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24578398OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1386673358
Entity Type Code : Organization
Provider Name (Legal Business Name) : RANDALLS FOOD & DRUGS LP
Provider Business Mailing Address
First Line : 250 E PARKCENTER BLVD
Second Line :
City : BOISE
State : ID
Zip : 83706-3940
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11920 PRESTON RD
Second Line :
City : DALLAS
State : TX
Zip : 75230-2711
Country : US
Telephone Number : 972-980-4915
Fax Number : 972-392-1506
Authorized Official
Title or Position : ENROLLMENTS MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 07/02/2006
Last Update Date : 07/05/2024

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Directions to “RANDALLS FOOD & DRUGS LP ” Practice Location

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