Randolph Medical Plus LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2001024010 Issued in MO

Legal business name

RANDOLPH MEDICAL PLUS LLC

Doing business as

Randolph Drug Store

Practice address

301 S Polk St
Maysville, MO 64469-4037

Phone

(816) 449-2700

Fax

(816) 449-5624

NPI assigned

Jul 14, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Kenton William Randolph

Title

Officer

Phone

(816) 449-2700

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Randolph Drug Store Doing business as

Tax ID family

Randolph Medical Plus LLC2 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.

• Randolph Medical Plus LLC

  dba Randolph Mobility and Wellness

  • Durable Medical Equipment & Medical Supplies
  • Saint Joseph, MO
  • NPI 1205828381
  NPD tax ID

Locations

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1952327108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 235",
            "city": "MAYSVILLE",
            "state": "MO",
            "postal_code": "644690235",
            "telephone_number": "816-449-2700",
            "fax_number": "816-449-5624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S POLK ST",
            "city": "MAYSVILLE",
            "state": "MO",
            "postal_code": "644694037",
            "telephone_number": "816-449-2700",
            "fax_number": "816-449-5624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH MEDICAL PLUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "KENTON",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "816-449-2700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2001024010",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MO",
            "license": "2001024010",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600284814",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randolph Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dekalb County Reorganized School District R-I
• Dekalb County Senate Bill 40
• N & R of Maysville, LLC (Sunset Home)
• Ginger R Neill Bundy, COTA/L
• Northwest Family Health, Inc. (Dekalb Health Services)
• Elisa Eh Vinyard
• Heather Willits, FNP-C
• Sierra Rae Wolf, DPT

• Community/Retail Pharmacy in Maysville, MO
• Providers in Maysville, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.