Provider Demographics
NPI:1144453556
Name:OGLE, RANDALL Y (RPH)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:Y
Last Name:OGLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTH HWY # I-29
Mailing Address - Street 2:
Mailing Address - City:HOGANSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30230-1436
Mailing Address - Country:US
Mailing Address - Phone:706-637-6461
Mailing Address - Fax:706-637-6514
Practice Address - Street 1:100 SOUTH HWY # I-29
Practice Address - Street 2:
Practice Address - City:HOGANSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30230-1436
Practice Address - Country:US
Practice Address - Phone:706-637-6461
Practice Address - Fax:706-637-6514
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist