Provider Demographics
NPI:1548981129
Name:RANDLE, JALISA NICOLE
Entity type:Individual
Prefix:DR
First Name:JALISA
Middle Name:NICOLE
Last Name:RANDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13003 TOMBALL PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-3122
Mailing Address - Country:US
Mailing Address - Phone:281-668-2883
Mailing Address - Fax:
Practice Address - Street 1:13003 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77086-3122
Practice Address - Country:US
Practice Address - Phone:281-668-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist