Provider Demographics
NPI:1548305139
Name:RANDOLPH, MELODY DAWN (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:DAWN
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 DEERHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-4690
Mailing Address - Country:US
Mailing Address - Phone:205-225-0475
Mailing Address - Fax:205-926-7662
Practice Address - Street 1:1130 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:AL
Practice Address - Zip Code:35042
Practice Address - Country:US
Practice Address - Phone:205-926-4821
Practice Address - Fax:205-926-7662
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist