Active NPI
Denise M. Tidwell, RPH
- Pharmacist
- Portsmouth, VA
National Provider Identifier
1376828640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202206163
- Practice address
- 620 John Paul Jones Cir
Portsmouth, VA 23708-2111 - Phone
- (757) 953-6974
- Fax
- (757) 953-7685
- NPI assigned
- Oct 18, 2011
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS56037 | FL | |
| Pharmacist | 183500000X | 8894 | SC | |
| Pharmacist | 183500000X | 0202206163 | VA | Primary |
Addresses
Primary practice location
620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Mailing address
620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Phone (757) 953-7462
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS56037 | FL | MD | Pharmacist |
| 0202206163 | VA | MD | Pharmacist |
| 8894 | SC | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eckerd Corporation | Past | Accepting new patients | |
| Eckerd Corporation | 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.
-
- Community/Retail Pharmacy
- Williamsburg, VA
- NPI 1245339480
-
- Community/Retail Pharmacy
- Virginia Beach, VA
- NPI 1982703120
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687478400000",
"number": "1376828640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 JOHN PAUL JONES CIR",
"city": "PORTSMOUTH",
"state": "VA",
"postal_code": "237082111",
"telephone_number": "757-953-7462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 JOHN PAUL JONES CIR",
"city": "PORTSMOUTH",
"state": "VA",
"postal_code": "237082111",
"telephone_number": "757-953-6974",
"fax_number": "757-953-7685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDWELL",
"first_name": "DENISE",
"middle_name": "M.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-18",
"last_updated": "2023-06-23",
"certification_date": "2023-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS56037",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "8894",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202206163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portsmouth, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.