NPIMap

Organization Active NPI

Cleveland Randolph, Jr, MD, PA

Doing business as C.W.Randolph's Pharmacy

  • Pharmacy
  • Jacksonville Beach, FL
National Provider Identifier
1629467782
Registry record updated Jan 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PH28647 Issued in FL
Legal business name
CLEVELAND RANDOLPH, JR, MD, PA
Doing business as
C.W.Randolph's Pharmacy
Practice address
1891 Beach Blvd
Jacksonville Beach, FL 32250-2644
Phone
(904) 746-3046
Fax
(904) 249-2047
NPI assigned
Jan 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2015

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

Authorized official

Name
Dr. Cleveland Randolph Jr., M.D.
Title
Owner
Phone
(904) 746-3046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PH28647 FL Primary

Addresses

Primary practice location

1891 Beach Blvd
Jacksonville Beach, FL 32250-2644

Mailing address

1891 Beach Blvd
Jacksonville Beach, FL 32250-2644
Phone (904) 746-3046

Other identifiers 1

IdentifierTypeStateIssuer
PH28647OtherFLPHARMACY LICENSE

Other names 1

  • C.W.Randolph's Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cleveland Randolph Jr MD2 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.

Practitioners & affiliated clinicians

Practitioners 6

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": "1421107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1629467782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 BEACH BLVD",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502644",
            "telephone_number": "904-746-3046",
            "fax_number": "904-249-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 BEACH BLVD",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502644",
            "telephone_number": "904-746-3046",
            "fax_number": "904-249-2047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND RANDOLPH, JR, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-13",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "CLEVELAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-746-3046",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "PH28647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "PH28647",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "C.W.Randolph's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.