Active NPI
Tieasher Peterson, PHARMD
- Pharmacist
- Portsmouth, VA
National Provider Identifier
1912697780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202210359
- Practice address
- 5829 High St W
Portsmouth, VA 23703-4503 - Phone
- (757) 686-6980
- NPI assigned
- May 15, 2023
- Last updated
- May 15, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202210359 | VA | Primary |
Addresses
Primary practice location
5829 High St W
Portsmouth, VA 23703-4503
Mailing address
3013 N James Dr
Suffolk, VA 23435-3352
Phone (757) 971-3021
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202210359 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1912697780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3013 N JAMES DR",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234353352",
"telephone_number": "757-971-3021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5829 HIGH ST W",
"city": "PORTSMOUTH",
"state": "VA",
"postal_code": "237034503",
"telephone_number": "757-686-6980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "TIEASHER",
"name_prefix": "Mrs.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-15",
"last_updated": "2023-05-15",
"certification_date": "2023-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202210359",
"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 May 15, 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.