Provider Demographics
NPI:1710254958
Name:LYDICK, LORA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:ANN
Last Name:LYDICK
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 1:4238 W HUNDRED RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1505
Mailing Address - Country:US
Mailing Address - Phone:804-706-1419
Mailing Address - Fax:804-706-1439
Practice Address - Street 1:4238 W HUNDRED RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1505
Practice Address - Country:US
Practice Address - Phone:804-706-1419
Practice Address - Fax:804-706-1439
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist