Provider Demographics
NPI:1124305974
Name:OFORI, RANDALL
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:OFORI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5773 MISSION CENTER RD
Mailing Address - Street 2:#203
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4381
Mailing Address - Country:US
Mailing Address - Phone:619-550-7499
Mailing Address - Fax:
Practice Address - Street 1:215 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7243
Practice Address - Country:US
Practice Address - Phone:619-401-0761
Practice Address - Fax:619-401-3435
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist