Provider Demographics
NPI:1437145828
Name:BICKFORD, RANDALL DALE (RPH)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:DALE
Last Name:BICKFORD
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 1:4675 LOCKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6931
Mailing Address - Country:US
Mailing Address - Phone:563-332-9172
Mailing Address - Fax:563-332-0804
Practice Address - Street 1:2900 DEVILS GLEN RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3363
Practice Address - Country:US
Practice Address - Phone:563-332-2983
Practice Address - Fax:563-332-0804
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist