Provider Demographics
NPI:1588874291
Name:LYLE, SIDNEY EARL (RPH)
Entity type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:EARL
Last Name:LYLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MRS
Other - First Name:ERMA
Other - Middle Name:JEAN
Other - Last Name:LYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JEAN
Mailing Address - Street 1:189 OAKVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750
Mailing Address - Country:US
Mailing Address - Phone:000-828-3792
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:189 OAKVIEW ROAD
Practice Address - Street 2:
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750
Practice Address - Country:US
Practice Address - Phone:000-828-3792
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist