Healthcare Provider Details

I. General information

NPI: 1760654073
Provider Name (Legal Business Name): RICK LOUDERMELT RPH, DPH, RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 11/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N HIGHWAY 25 W
WILLIAMSBURG KY
40769-1576
US

IV. Provider business mailing address

PO BOX 698
WILLIAMSBURG KY
40769-0698
US

V. Phone/Fax

Practice location:
  • Phone: 606-215-6352
  • Fax: 877-792-5105
Mailing address:
  • Phone: 606-215-6352
  • Fax: 877-792-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2083
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12304
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11957
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12249
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: