1639191174 NPI number — MR. RANDY C WRIGHT RPH

Table of content: MR. RANDY C WRIGHT RPH (NPI 1639191174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639191174 NPI number — MR. RANDY C WRIGHT RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
RANDY
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639191174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAUDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79019-0129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-226-2221
Provider Business Mailing Address Fax Number:
806-226-2309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PARKS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAUDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-226-2221
Provider Business Practice Location Address Fax Number:
806-226-2309
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  22397 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22397 . This is a "PHARMACIST CERTIFICATE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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