Provider Demographics
NPI:1861884702
Name:NEMECEK, RANDY SAMSON (PHARMD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:SAMSON
Last Name:NEMECEK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19315 YELLOW CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3669
Mailing Address - Country:US
Mailing Address - Phone:813-295-3290
Mailing Address - Fax:
Practice Address - Street 1:19315 YELLOW CLOVER DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3669
Practice Address - Country:US
Practice Address - Phone:813-295-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS46861OtherPHARMACIST LICENSE