Active NPI
Clint Roderick IV, RPH
- Pharmacist
- York, PA
National Provider Identifier
1275811929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP038439L
- Practice address
- 912 S George St
York, PA 17403-3700 - Phone
- (717) 741-8151
- NPI assigned
- Jul 29, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP038439L | PA | Primary |
Addresses
Primary practice location
912 S George St
York, PA 17403-3700
Mailing address
306 Rumford Rd
Lititz, PA 17543-9012
Phone (717) 578-2627
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RP038439L | Other | PA | PA PHARMACIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP038439L | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311897600000",
"number": "1275811929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 RUMFORD RD",
"city": "LITITZ",
"state": "PA",
"postal_code": "175439012",
"telephone_number": "717-578-2627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 S GEORGE ST",
"city": "YORK",
"state": "PA",
"postal_code": "174033700",
"telephone_number": "717-741-8151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODERICK",
"first_name": "CLINT",
"name_prefix": "Mr.",
"name_suffix": "IV",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-29",
"last_updated": "2011-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP038439L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA PHARMACIST LICENSE",
"identifier": "RP038439L",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in York, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.