Organization
RANDALLS FOOD & DRUGS LP
Active
Other names
RANDALLS PHARMACY #1779
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY GIANNAKOPOULOS (ENROLLMENTS MANAGER)
(208) 395-3954
Entity
Organization
Contact information
Practice address
2303 RANCH ROAD 620 S, LAKEWAY, TX 78734-6219
(512) 263-3105
(512) 263-3196
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
22109
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4590508
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
463692
—
TX
Enumeration date
07/02/2006
Last updated
06/12/2024
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