Provider Demographics
NPI:1184607954
Name:WIDDUP, LORIE L (RPH PHARMD CDE)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:L
Last Name:WIDDUP
Suffix:
Gender:F
Credentials:RPH PHARMD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HUNTINGTON WOODS
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8245
Mailing Address - Country:US
Mailing Address - Phone:724-627-4046
Mailing Address - Fax:724-627-4046
Practice Address - Street 1:1440 E HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-9558
Practice Address - Country:US
Practice Address - Phone:724-627-6486
Practice Address - Fax:724-627-9513
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-034971-R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist