Provider Demographics
NPI:1164600862
Name:MARLOW, LYDIA ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ANN
Last Name:MARLOW
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 1:9 CHAUNCY CT
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-9565
Mailing Address - Country:US
Mailing Address - Phone:518-399-2047
Mailing Address - Fax:
Practice Address - Street 1:1409 ALTAMONT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-2904
Practice Address - Country:US
Practice Address - Phone:518-355-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00528836Medicaid