Provider Demographics
NPI:1003019258
Name:COLLIER, LYDELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LYDELL
Middle Name:
Last Name:COLLIER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HEATHERSPRING CT.
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806
Mailing Address - Country:US
Mailing Address - Phone:256-837-6240
Mailing Address - Fax:
Practice Address - Street 1:444 WYNN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-3426
Practice Address - Country:US
Practice Address - Phone:256-837-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist