NPIMap

Organization Active NPI

Randolph Pharmacy

  • Community/Retail Pharmacy
  • Randolph, MA
National Provider Identifier
1619221322
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
RANDOLPH PHARMACY
Practice address
1187 N Main St
Randolph, MA 02368-2135
Phone
(617) 750-2588
NPI assigned
Nov 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Mr. Triet Minh Ngo, PHARM DNPI 1912341025
Title
Owner
Phone
(781) 885-1181

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

1187 N Main St
Randolph, MA 02368-2135

Mailing address

1187 N Main St
Randolph, MA 02368-2135
Phone (781) 885-1181

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130730000188 MA DME Supplier - Pharmacy 1850532151 Practice locations: Randolph, MA
O20170907002025 MA Part B Supplier - Mass Immunization (Roster Biller Only) 1850532151 Practice locations: Randolph, MA

National Provider Directory

National Provider Directory
Tax ID family
Randolph Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1187 N Main St
Randolph, MA 02368
Phone (781) 885-1181

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1351728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1619221322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1187 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023682135",
            "telephone_number": "781-885-1181",
            "fax_number": "781-885-1284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1187 N MAIN ST",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023682135",
            "telephone_number": "617-750-2588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-01",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "NGO",
        "authorized_official_first_name": "TRIET",
        "authorized_official_middle_name": "MINH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-885-1181",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.