Provider Demographics
NPI:1518374727
Name:RODICK, KEVIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RODICK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5436
Mailing Address - Country:US
Mailing Address - Phone:626-463-2096
Mailing Address - Fax:626-463-2100
Practice Address - Street 1:2408 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-5436
Practice Address - Country:US
Practice Address - Phone:626-463-2096
Practice Address - Fax:626-463-2100
Is Sole Proprietor?:No
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist