Provider Demographics
NPI:1679896062
Name:MCBRIDE, RANDI KIRSTEN (RPH)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:KIRSTEN
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38-42 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07422
Mailing Address - Country:US
Mailing Address - Phone:973-875-4141
Mailing Address - Fax:973-845-0529
Practice Address - Street 1:38-42 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:NJ
Practice Address - Zip Code:07422
Practice Address - Country:US
Practice Address - Phone:973-875-4141
Practice Address - Fax:973-845-0529
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01935200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist