Provider Demographics
NPI:1497867006
Name:KIDDY, LORI LYNNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNNE
Last Name:KIDDY
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 1:935 PINECREST DR
Mailing Address - Street 2:C-3
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1942
Mailing Address - Country:US
Mailing Address - Phone:301-268-1606
Mailing Address - Fax:
Practice Address - Street 1:19 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONACONING
Practice Address - State:MD
Practice Address - Zip Code:21539-1122
Practice Address - Country:US
Practice Address - Phone:301-463-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10773OtherPHARMACIST