Randolph Ernest Margrave, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS0020769 Issued in FL

Practice address

1702 Ridgewood Ave Ste C
Holly Hill, FL 32117-5402

Phone

(386) 677-7377

Fax

(844) 677-0739

NPI assigned

Nov 16, 2019

Last updated

Nov 16, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Xinim Corporation

  dba Holly Hill Pharmacy

  • Pharmacy
  • Holly Hill, FL
  • NPI 1932109667
  NPD (past)

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

{
    "created_epoch": "1573862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573862400000",
    "number": "1679118343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3742 CARDINAL BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321187204",
            "telephone_number": "386-451-7418",
            "fax_number": "844-677-0739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 RIDGEWOOD AVE STE C",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321175402",
            "telephone_number": "386-677-7377",
            "fax_number": "844-677-0739"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1702 Ridgewood Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Holly Hill",
            "state": "FL",
            "postal_code": "321171783",
            "country_code": "US",
            "telephone_number": "904-458-5444",
            "fax_number": "386-760-7417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARGRAVE",
        "first_name": "RANDOLPH",
        "middle_name": "ERNEST",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-16",
        "last_updated": "2019-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835N1003X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Nutrition Support",
            "state": "FL",
            "license": "PU0002896",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "FL",
            "license": "PS0020769",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS0020769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "PS0020769",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "randy@hollyhillpharmacy.com",
            "affiliation": "N",
            "endpointDescription": "Pharmacy",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1702 Ridgewood Ave Ste C",
            "city": "Holly Hill",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321175402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Therese Jeanne Leeds, LMT
• Live Love Life, Inc (Live Love Life, Holly Hill)
• Harriette Lockley
• Lovey's Afch
• Loveys's Alf LLC
• Jessica Lauren Mason, PHARM D
• Wendy A McBean
• Beverly Sue McKean, REGISTERED NURSE
• Angela Miles, LCSW
• Jackie S Miller, RPH

• Pharmacist in Holly Hill, FL
• Providers in Holly Hill, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2019; 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.