Provider Demographics
NPI:1255526372
Name:LIBBY, ARDELLE LUCILLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ARDELLE
Middle Name:LUCILLE
Last Name:LIBBY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ARDELLE
Other - Middle Name:LIBBY
Other - Last Name:SEELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3160 WILDCAT FLAT TRL
Mailing Address - Street 2:
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-2549
Mailing Address - Country:US
Mailing Address - Phone:619-855-2320
Mailing Address - Fax:
Practice Address - Street 1:3160 WILDCAT FLAT TRL
Practice Address - Street 2:
Practice Address - City:COOL
Practice Address - State:CA
Practice Address - Zip Code:95614-2549
Practice Address - Country:US
Practice Address - Phone:619-855-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597611835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy