Provider Demographics
NPI:1760654073
Name:LOUDERMELT, RICK (RPH, DPH, RD, LD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:LOUDERMELT
Suffix:
Gender:M
Credentials:RPH, DPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-0698
Mailing Address - Country:US
Mailing Address - Phone:606-215-6352
Mailing Address - Fax:877-792-5105
Practice Address - Street 1:475 N HIGHWAY 25 W
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1576
Practice Address - Country:US
Practice Address - Phone:606-215-6352
Practice Address - Fax:877-792-5105
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2083133V00000X
KY12304183500000X
TN11957183500000X
AL12249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11896924OtherCAQH
KYRD00017Medicare PIN