Provider Demographics
NPI:1366803470
Name:RANDALL, JOE (RPH)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:RANDALL
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 1:3151 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7813
Mailing Address - Country:US
Mailing Address - Phone:406-449-2295
Mailing Address - Fax:406-441-4928
Practice Address - Street 1:3151 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7813
Practice Address - Country:US
Practice Address - Phone:406-449-2295
Practice Address - Fax:406-441-4928
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist