Provider Demographics
NPI:1386924983
Name:RANDALL, ALLISON J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:J
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 MONTILLA DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3411
Mailing Address - Country:US
Mailing Address - Phone:401-487-3934
Mailing Address - Fax:
Practice Address - Street 1:6790 DANIELS PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7521
Practice Address - Country:US
Practice Address - Phone:239-433-4091
Practice Address - Fax:239-433-4920
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist