Provider Demographics
NPI:1275416083
Name:KIDD, ISAAC SCOTT
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:SCOTT
Last Name:KIDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 NC HIGHWAY 42 S
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-8735
Mailing Address - Country:US
Mailing Address - Phone:336-465-3752
Mailing Address - Fax:
Practice Address - Street 1:440 E DIXIE DR
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6860
Practice Address - Country:US
Practice Address - Phone:336-625-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist