NPIMap

Individual provider Active NPI

Kristy L Liddic, PHARM D

  • Pharmacist
  • Nottingham, MD
National Provider Identifier
1063633097
Registry record updated Nov 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
17971 Issued in MD
Practice address
8669 Belair Rd
Nottingham, MD 21236-2703
Phone
(410) 256-2844
Fax
(410) 256-5376
NPI assigned
May 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 17971 MD Primary
Pharmacist 183500000X 0202206183 VA

Addresses

Primary practice location

8669 Belair Rd
Nottingham, MD 21236-2703

Mailing address

1203 Leeds CT
Abingdon, MD 21009
Phone (410) 676-0240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
17971MDMDPharmacist
0202206183VAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland CVS Pharmacy LLC Past Accepting new patients
South Carolina CVS Pharmacy LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448150400000",
    "number": "1063633097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 LEEDS CT",
            "city": "ABINGDON",
            "state": "MD",
            "postal_code": "21009",
            "telephone_number": "410-676-0240",
            "fax_number": "410-420-9068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8669 BELAIR RD",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212362703",
            "telephone_number": "410-256-2844",
            "fax_number": "410-256-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDDIC",
        "first_name": "KRISTY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2015-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "17971",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202206183",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nottingham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.