Organization
RANDYS HOUSE OF MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE WYATT (OWNER)
(601) 785-6812
Entity
Organization
Contact information
Practice address
305 FRONT ST, TAYLORSVILLE, MS 39168-0818
(601) 785-6812
(601) 785-4993
Mailing address
PO BOX 818, TAYLORSVILLE, MS 39168-0818
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
01523
MS
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040383
—
MS
05
—
0030655
—
MS
01
—
2515382
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
03/15/2007
Last updated
09/11/2025
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