Provider Demographics
NPI:1053031369
Name:RANDYS PHARMACY (LTC)
Entity type:Organization
Organization Name:RANDYS PHARMACY (LTC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAYZE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-256-6600
Mailing Address - Street 1:1310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3002
Mailing Address - Country:US
Mailing Address - Phone:580-256-6600
Mailing Address - Fax:
Practice Address - Street 1:1310 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3002
Practice Address - Country:US
Practice Address - Phone:580-256-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANDY'S PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy