Organization
RANDALLS FOOD & DRUGS LP
Active
Other names
TOM THUMB PHARMACY #1785
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
1075 W ROUND GROVE RD, LEWISVILLE, TX 75067-7904
(214) 488-3068
(214) 488-3081
Mailing address
250 E PARKCENTER BLVD, BOISE, ID 83706-3940
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
22115
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4512934
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
464393
—
TX
Enumeration date
07/02/2006
Last updated
07/05/2024
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