Provider Demographics
NPI:1457698490
Name:VALENTINE, LIDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIDA
Middle Name:
Last Name:VALENTINE
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 1:4279 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3769
Mailing Address - Country:US
Mailing Address - Phone:404-843-4358
Mailing Address - Fax:404-843-4302
Practice Address - Street 1:4279 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3769
Practice Address - Country:US
Practice Address - Phone:404-843-4358
Practice Address - Fax:404-843-4302
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist