Provider Demographics
NPI:1023354511
Name:GUY, RANDY FERRELL (RPH)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:FERRELL
Last Name:GUY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:201 COMMERCE ST
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-0426
Mailing Address - Country:US
Mailing Address - Phone:251-246-2271
Mailing Address - Fax:
Practice Address - Street 1:201 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2717
Practice Address - Country:US
Practice Address - Phone:251-246-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10303OtherSTATE LICENSE NUMBER