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NPI Code Detail

MEDICARE: DR. MONA LISA RANDOLPH PHARM D

MEDICARE: DR. MONA LISA RANDOLPH PHARM D
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
1183500000XPharmacist53452TX

General Provider Information

NPI Number : 1912339649
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MONA LISA RANDOLPH PHARM D
Provider Business Mailing Address
First Line : 5601 W AMARILLO BLVD
Second Line :
City : AMARILLO
State : TX
Zip : 79106-4141
Country : US
Telephone Number : 806-352-6650
Fax Number : 806-352-7833
Provider Business Practice Location Address
First Line : 5601 W AMARILLO BLVD
Second Line :
City : AMARILLO
State : TX
Zip : 79106-4141
Country : US
Telephone Number : 806-352-6650
Fax Number : 806-352-7833
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2013
Last Update Date : 07/23/2019

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