Provider Demographics
NPI:1194352096
Name:ENCIO, RANDY (DO)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:ENCIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3917
Mailing Address - Country:US
Mailing Address - Phone:305-331-0339
Mailing Address - Fax:
Practice Address - Street 1:12800 BISCAYNE BLVD.
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3318
Practice Address - Country:US
Practice Address - Phone:305-913-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist