MEDICARE: MR. RANDY J RODRIGUEZ II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1300X	Psychiatric Pharmacist	7	KY

General Provider Information

NPI Number	:	1629853494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY J RODRIGUEZ II

Provider Business Mailing Address
First Line	:	3436 CLAYS MILL RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-4146
Country	:	US
Telephone Number	:	859-684-9907
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 CLAYS MILL RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-4146
Country	:	US
Telephone Number	:	859-684-9907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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