Randalls Food & Drugs LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

22082 Issued in TX

Legal business name

RANDALLS FOOD & DRUGS LP

Doing business as

TOM THUMB PHARMACY #1789

Practice address

101 Trophy Lake Dr
Trophy Club, TX 76262-5233

Phone

(817) 490-6968

Fax

(817) 490-6985

NPI assigned

Jul 2, 2006

Organization subpart

Yes

Parent organization

SAFEWAY INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tiffany Eliopulos

Title

Assistant Manager, Enrollments

Phone

(208) 395-3906

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• TOM THUMB PHARMACY #1789 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Part of

Safeway Pharmacy 1073

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Safeway Inc

  • Community/Retail Pharmacy
  • Sunnyside, WA
  • NPI 1861421885

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541030400000",
    "number": "1427087485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 TROPHY LAKE DR",
            "city": "TROPHY CLUB",
            "state": "TX",
            "postal_code": "762625233",
            "telephone_number": "817-490-6968",
            "fax_number": "817-490-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALLS FOOD & DRUGS LP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAFEWAY INC",
        "enumeration_date": "2006-07-02",
        "last_updated": "2018-11-01",
        "status": "A",
        "authorized_official_last_name": "ELIOPULOS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "ASSISTANT MANAGER, ENROLLMENTS",
        "authorized_official_telephone_number": "208-395-3906"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "22082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4515803",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "464709",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TOM THUMB PHARMACY #1789",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TOM THUMB PHARMACY #1789",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Perez, PT
• Ryan Perez, DPT
• Sydney Pettyjohn, RN, IBCLC
• Hong Hanh Tanis Phan
• Pro Physicians Clinic PA
• Jacquelyn Rapp
• Respiratory Sleep Solutions, Inc.
• Andrea Lynn Rice, M.S.
• Alexandra Richmond
• Kathryn Wright Rodgers, PHARM D.

• Community/Retail Pharmacy in Trophy Club, TX
• Providers in Trophy Club, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.