Provider Demographics
NPI:1033953930
Name:AVERY, LYDIA MAE (PHARMD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MAE
Last Name:AVERY
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 1:257 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2204
Mailing Address - Country:US
Mailing Address - Phone:330-307-0566
Mailing Address - Fax:
Practice Address - Street 1:143 GOUGLER AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2401
Practice Address - Country:US
Practice Address - Phone:330-785-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH060002347183700000X
OH03444700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician