Provider Demographics
NPI:1902406507
Name:ORR, LYDIA ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ROSE
Last Name:ORR
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 1:1242 CARTER 173
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63941-8156
Mailing Address - Country:US
Mailing Address - Phone:417-247-1531
Mailing Address - Fax:
Practice Address - Street 1:101 W US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548-8542
Practice Address - Country:US
Practice Address - Phone:417-934-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist