Provider Demographics
NPI:1992361109
Name:VON WALD, LYDIA (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:
Last Name:VON WALD
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:DR
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:CHIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH, PHARMD
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-1246
Mailing Address - Country:US
Mailing Address - Phone:214-315-5016
Mailing Address - Fax:
Practice Address - Street 1:5353 YELLOWSTONE RD STE 211
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4178
Practice Address - Country:US
Practice Address - Phone:888-385-0235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022642183500000X
TX57436183500000X
WY4140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist