Provider Demographics
NPI:1063633097
Name:LIDDIC, KRISTY L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:L
Last Name:LIDDIC
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 LEEDS CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009
Mailing Address - Country:US
Mailing Address - Phone:410-676-0240
Mailing Address - Fax:410-420-9068
Practice Address - Street 1:8669 BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2703
Practice Address - Country:US
Practice Address - Phone:410-256-2844
Practice Address - Fax:410-256-5376
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17971183500000X
VA0202206183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist