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1578167086 NPI number — KALEB LYDA PHARMD

NPI Number: 1578167086
Health Care Provider/Practitioner: KALEB LYDA PHARMD

Information about “1578167086” NPI (KALEB LYDA PHARMD) exists in 1578167086 in HTML format HTML  |  1578167086 in plain Text format TXT  |  1578167086 in PDF (Portable Document Format) PDF  |  1578167086 in an XML format XML  formats.

NPI Number : 1578167086 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578167086",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LYDA",
    "FirstName": "KALEB",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3573 PHILWOOD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38122-4557",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-991-9536",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "240 NEW BYHALIA RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLLIERVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38017-3716",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-853-1331",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/24/2020",
    "LastUpdateDate": "08/26/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "21438",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "44242",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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