Active NPI
Shaquan Nicole Lyde, PHARMD
- Pharmacist
- Charleston, SC
National Provider Identifier
1265082135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 42239
- Practice address
- 907 Folly Rd
Charleston, SC 29412-3919 - Phone
- (843) 795-5452
- NPI assigned
- Sep 12, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 42239 | SC | Primary |
Addresses
Primary practice location
907 Folly Rd
Charleston, SC 29412-3919
Mailing address
907 Folly Rd
Charleston, SC 29412-3919
Phone (843) 795-5452
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
| License | State | Type | Specialty |
|---|---|---|---|
| 42239 | SC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
907 Folly Rd
Charleston, SC 29412
Phone (843) 795-5452
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": "1568246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568246400000",
"number": "1265082135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "907 FOLLY RD",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294123919",
"telephone_number": "843-795-5452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "907 FOLLY RD",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294123919",
"telephone_number": "843-795-5452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYDE",
"first_name": "SHAQUAN",
"middle_name": "NICOLE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-12",
"last_updated": "2019-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "42239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.