Organization
RANDOLPH MEDICAL PLUS LLC
Active
Other names
Randolph Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENTON WILLIAM RANDOLPH (OFFICER)
(816) 449-2700
Entity
Organization
Contact information
Practice address
301 S POLK ST, MAYSVILLE, MO 64469-4037
(816) 449-2700
(816) 449-5624
Mailing address
PO BOX 235, MAYSVILLE, MO 64469-0235
(816) 449-2700
(816) 449-5624
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2001024010
MO
3336L0003X
Long Term Care Pharmacy
2001024010
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600284814
—
MO
Enumeration date
07/14/2006
Last updated
09/23/2024
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