Provider Demographics
NPI:1033722715
Name:TERRY, LYDIA CAPPS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:CAPPS
Last Name:TERRY
Suffix:
Gender:F
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:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-0254
Mailing Address - Country:US
Mailing Address - Phone:270-535-5677
Mailing Address - Fax:
Practice Address - Street 1:360 KEEN ST STE 100
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717-7916
Practice Address - Country:US
Practice Address - Phone:270-864-2222
Practice Address - Fax:270-864-2228
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist