Provider Demographics
NPI:1619049525
Name:KIDD, ANNE CARLISLE (RPH BCPP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:CARLISLE
Last Name:KIDD
Suffix:
Gender:F
Credentials:RPH BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 SUNBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-7689
Mailing Address - Country:US
Mailing Address - Phone:540-989-7319
Mailing Address - Fax:
Practice Address - Street 1:1902 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7304
Practice Address - Country:US
Practice Address - Phone:540-772-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020071581835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric