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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
2333600000XPharmacy22093TX
33336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14579794OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790721314
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 : 208-395-3920
Fax Number : 623-336-6896
Provider Business Practice Location Address
First Line : 6377 CAMP BOWIE BLVD
Second Line :
City : FT WORTH
State : TX
Zip : 76116-5473
Country : US
Telephone Number : 817-731-2977
Fax Number : 817-731-0377
Authorized Official
Title or Position : ENROLLMENTS MANAGER
Name : KATHY GIANNAKOPOULOS
Credential :
Telephone Number : 208-395-3954
Provider Enumeration Date : 06/21/2006
Last Update Date : 07/05/2024

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Directions to “RANDALLS FOOD & DRUGS LP ” Practice Location

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