Healthcare Provider Details

I. General information

NPI: 1073425559
Provider Name (Legal Business Name): KEVIN ARMANDO RUIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 STATE ROUTE 741
MASON OH
45040-2337
US

IV. Provider business mailing address

5777 RODEN PARK DR
LIBERTY TOWNSHIP OH
45044-7797
US

V. Phone/Fax

Practice location:
  • Phone: 513-398-8820
  • Fax:
Mailing address:
  • Phone: 513-288-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03447311
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: