Provider Demographics
NPI:1033457346
Name:BIDDULPH, LISA ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:BIDDULPH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVER VISTA DR UNIT 537
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7618
Mailing Address - Country:US
Mailing Address - Phone:770-547-4838
Mailing Address - Fax:
Practice Address - Street 1:6120 ALABAMA HWY
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2804
Practice Address - Country:US
Practice Address - Phone:706-935-5444
Practice Address - Fax:706-935-5443
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist