MEDICARE: MR. THOMAS ANTHONY RANDAZZO 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	183500000X	Pharmacist	040768	NY

General Provider Information

NPI Number	:	1851577530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ANTHONY RANDAZZO RPH

Provider Business Mailing Address
First Line	:	310 E 2ND ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-8150
Country	:	US
Telephone Number	:	646-434-4344
Fax Number	:	646-434-4345

Provider Business Practice Location Address
First Line	:	8432 JAMAICA AVE
Second Line	:
City	:	WOODHAVEN
State	:	NY
Zip	:	11421-1920
Country	:	US
Telephone Number	:	718-277-5814
Fax Number	:	718-277-7599

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

Provider Enumeration Date	:	01/13/2008
Last Update Date	:	10/02/2018

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