Active NPI
David L Randolph, RP
- Pharmacist
- Alliance, NE
National Provider Identifier
1477617439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10869
- Practice address
- 2101 Box Butte Ave
Alliance, NE 69301-4445 - Phone
- (308) 762-6660
- Fax
- (308) 762-1923
- NPI assigned
- Dec 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10869 | NE | Primary |
Addresses
Primary practice location
2101 Box Butte Ave
Alliance, NE 69301-4445
Mailing address
1128 Sheridan Ave
Alliance, NE 69301-2342
Phone (308) 760-2287
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10869 | NE | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Keystone Health LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Hemingford, NE
- NPI 1780360297
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477617439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1128 SHERIDAN AVE",
"city": "ALLIANCE",
"state": "NE",
"postal_code": "693012342",
"telephone_number": "308-760-2287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 BOX BUTTE AVE",
"city": "ALLIANCE",
"state": "NE",
"postal_code": "693014445",
"telephone_number": "308-762-6660",
"fax_number": "308-762-1923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "DAVID",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "RP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NE",
"license": "10869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alliance, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.