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Provider Information for 1982633947


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RANDALLS FOOD & DRUGS LP

Other Names:  
Doing Business As: 
TOM THUMB PHARMACY #1784

Organization Subpart: NO

NPI: 1982633947
Last Updated: 2024-06-12
Certification Date: 2024-06-12

Details

NameValue
NPI1982633947
Enumeration Date2006-07-02
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: KATHY GIANNAKOPOULOS
Title: Enrollments Manager
Phone: 2083953954
Mailing Address 250 E PARKCENTER BLVD
BOISE, ID 83706-3940
United States

Phone: | Fax:
 
Primary Practice Address 1501 PIONEER RD
MESQUITE, TX 75149-6032
United States

Phone: 972-290-3358 | Fax:972-290-3371
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)4512946Other ID Number-Commercial Number
MEDICAIDTX464392
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 333600000X - Pharmacy TX22080
Yes 3336C0003X - Pharmacy - Community/Retail Pharmacy