Organization
RANDALLS FOOD & DRUGS LP
Active
Other names
Randalls Pharmacy #2987
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
5145 N FM 620, SUITE A, AUSTIN, TX 78732-1815
(512) 266-1392
(512) 266-4796
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
24849
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
466806
—
TX
01
—
5905306
NCPDP
TX
Enumeration date
03/06/2012
Last updated
07/05/2024
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