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General NPI Number Information
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NPI Number | 1578167086
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Entity Type | Individual
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Provider Name | KALEB LYDA PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 240 NEW BYHALIA RD
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City | COLLIERVILLE
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State | TN
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Zip | 38017-3716
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Country | US
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Telephone | 901-853-1331
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Fax |
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Provider Business Mailing Address
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Address Line | 3573 PHILWOOD AVE
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City | MEMPHIS
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State | TN
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Zip | 38122-4557
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Country | US
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Telephone | 423-991-9536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21438
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 44242
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License Number State | TN
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