Healthcare Provider Details

I. General information

NPI: 1629853494
Provider Name (Legal Business Name): MR. RANDY J RODRIGUEZ II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 CLAYS MILL RD
LEXINGTON KY
40503-4146
US

IV. Provider business mailing address

3436 CLAYS MILL RD
LEXINGTON KY
40503-4146
US

V. Phone/Fax

Practice location:
  • Phone: 859-684-9907
  • Fax:
Mailing address:
  • Phone: 859-684-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number7
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: