Provider Demographics
NPI:1588956486
Name:RANDOLPH, JENNIFER MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:RANDOLPH
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 1:210 BUCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3150
Mailing Address - Country:US
Mailing Address - Phone:585-750-0004
Mailing Address - Fax:
Practice Address - Street 1:600 GREECE RIDGE CENTER DR
Practice Address - Street 2:TARGET PHARMACY T-1194
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2825
Practice Address - Country:US
Practice Address - Phone:585-225-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist