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General NPI Number Information
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NPI Number | 1871002485
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Entity Type | Organization
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Legal Business Name | LIDO PHARMACY LLC
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 361 HOSPITAL RD STE 425
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3525
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Country | US
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Telephone | 949-524-3566
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Fax |
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Provider Business Mailing Address
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Address Line | 361 HOSPITAL RD STE 425
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3525
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Country | US
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Telephone | 949-524-3566
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STEPHEN THOMAS HOM
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Credential |
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Telephone | 760-217-9250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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