Healthcare Provider Details

I. General information

NPI: 1942881321
Provider Name (Legal Business Name): AIDAN ROBERT SOUTHWORTH CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2021
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 ROCKSIDE RD
CLEVELAND OH
44125-6134
US

IV. Provider business mailing address

1499 N FORBES RD
LEXINGTON KY
40511-2013
US

V. Phone/Fax

Practice location:
  • Phone: 216-369-2200
  • Fax: 216-369-2201
Mailing address:
  • Phone: 859-314-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT00354743
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: