Provider Demographics
NPI:1477610327
Name:TSUBOI, CLIFFORD PATRIC
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:PATRIC
Last Name:TSUBOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 MONTAVESTA RD
Mailing Address - Street 2:APT D-16
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3554
Mailing Address - Country:US
Mailing Address - Phone:859-266-9881
Mailing Address - Fax:
Practice Address - Street 1:3349 TATES CREEK RD
Practice Address - Street 2:LANSDOWNE SHOPPING CENTER
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3467
Practice Address - Country:US
Practice Address - Phone:859-266-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist