Provider Demographics
NPI:1427300086
Name:HAIRE, RANDOLPH D (PHARMACIST)
Entity type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:D
Last Name:HAIRE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15555 STARFISH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2457
Mailing Address - Country:US
Mailing Address - Phone:850-236-3721
Mailing Address - Fax:850-636-6521
Practice Address - Street 1:15555 STARFISH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2457
Practice Address - Country:US
Practice Address - Phone:850-236-3721
Practice Address - Fax:850-636-6521
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist