Provider Demographics
NPI:1316384670
Name:SUDOL, LIDIA ADRIANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:ADRIANA
Last Name:SUDOL
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 1582
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-1582
Mailing Address - Country:US
Mailing Address - Phone:970-468-5369
Mailing Address - Fax:970-468-5110
Practice Address - Street 1:300 DILLON RIDGE RD
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-1582
Practice Address - Country:US
Practice Address - Phone:970-468-5369
Practice Address - Fax:970-468-5110
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist