Provider Demographics
NPI:1841187846
Name:RANDALL, SEMON FARIDA BASAR
Entity type:Individual
Prefix:
First Name:SEMON
Middle Name:FARIDA BASAR
Last Name:RANDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SEMON
Other - Middle Name:FARIDA
Other - Last Name:BASAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 NATHANIEL DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2412
Mailing Address - Country:US
Mailing Address - Phone:925-325-2889
Mailing Address - Fax:
Practice Address - Street 1:219 FISHERVILLE RD UNIT C
Practice Address - Street 2:
Practice Address - City:PENACOOK
Practice Address - State:NH
Practice Address - Zip Code:03303-2074
Practice Address - Country:US
Practice Address - Phone:603-565-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-05169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist