Walter Von Brock Sidwell, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

S12081 Issued in AL

Practice address

27955 US Highway 98 Ste 1
Daphne, AL 36526-4700

Phone

(251) 626-1349

NPI assigned

Jul 27, 2020

Last updated

Jul 27, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Publix Alabama, LLC

  dba Publix Pharmacy #2098

  • Community/Retail Pharmacy
  • Foley, AL
  • NPI 1326856592
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1790394765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 MAXWELL AVE",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365264054",
            "telephone_number": "615-618-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27955 US HIGHWAY 98 STE 1",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365264700",
            "telephone_number": "251-626-1349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDWELL",
        "first_name": "WALTER",
        "middle_name": "VON BROCK",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PSI40131",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AL",
            "license": "S12081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherri L Crane LMFT LLC
• John Denton Sherrod, MD
• Shield of Faith Counseling LLC
• Karen Shoemaker, MA,CCC/SLP
• Nicole P Shoemaker
• Sarah Siefert, PHARMD
• Mark Siegel, MD
• Lauralee Simpsiridis, PMHNP-BC, ALC
• Mary Ashley Simpson, ALC
• Peter B. Sinks, MD

• Pharmacist in Daphne, AL
• Providers in Daphne, AL by specialty
• Pharmacist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.