Active NPI
Randalls Food & Drugs LP
- Community/Retail Pharmacy
- Dallas, TX
National Provider Identifier
1629014246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- RANDALLS FOOD & DRUGS LP
- Practice address
- 6333 E Mockingbird LN
Dallas, TX 75214-2692 - Phone
- (214) 823-9916
- Fax
- (214) 821-7269
- NPI assigned
- Jun 21, 2006
- Organization subpart
- Yes
- Parent organization
- SAFEWAY INC
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 22166 | TX | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
6333 E Mockingbird LN
Dallas, TX 75214-2692
Mailing address
250 E Parkcenter Blvd
Boise, ID 83706-3940
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4517768 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 463792 | Medicaid | TX |
Other names 1
- TOM THUMB PHARMACY #2534
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040819001034 | TX | Part B Supplier - Centralized Flu Biller | 6901703974 |
This NPI is an additional NPI on the enrollment Practice locations: Houston, TX |
| O20100930068064 | TX | DME Supplier - Pharmacy | 6901703974 | Practice locations: Dallas, TX |
National Provider Directory
National Provider Directory- Part of
- Safeway Pharmacy 1073
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1541116800000",
"number": "1629014246",
"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": "6333 E MOCKINGBIRD LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752142692",
"telephone_number": "214-823-9916",
"fax_number": "214-821-7269"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RANDALLS FOOD & DRUGS LP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SAFEWAY INC",
"enumeration_date": "2006-06-21",
"last_updated": "2018-11-02",
"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": "TX",
"license": "22166",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "4517768",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "463792",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "TOM THUMB PHARMACY #2534",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "TOM THUMB PHARMACY #2534",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.