Basic Information
| Provider Information | |||||||||
| NPI: | 1033182068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12141 AMBER RIDGE CIR | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208763953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015402926 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NNMC PHARMACY DEPARTMENT | ||||||||
| Address2: | 8901 WISCONSIN AVE | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013194214 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 16018 | LA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.