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
1	333600000X	Pharmacy	22025	TX
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4561608	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1962448746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALLS FOOD & DRUGS LP

Provider Business Mailing Address
First Line	:	20427 N 27TH AVE # MSC4551
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 HIGHWAY 6 N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2505
Country	:	US
Telephone Number	:	281-463-3701
Fax Number	:	281-856-3834

Authorized Official
Title or Position	:	MANAGED CARE PLAN SPECILAIST
Name	:	MICHELLE ANN RIVERS
Credential	:	CPHT
Telephone Number	:	623-869-3524

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	05/26/2017

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Directions to “RANDALLS FOOD & DRUGS LP ” Practice Location

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