TIDEWATER DIVERSIFIED, INC. (NPI# 1275557860) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275557860 |
| Entity Type | Organization |
| Organization Name | TIDEWATER DIVERSIFIED, INC. |
| Other Organization Name | ATRIUM PHARMACY |
| Practice Address |
155 Kingsley Ln Ste 125 Norfolk VA 23505-4629 |
| Mailing Address |
160 Kingsley Ln Norfolk VA 23505-4600 |
| Practice Telephone | 7572782150 |
| Practice Fax Number | 7574891280 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-11-20 |
| Authorized Official Name | TRACY M BERRIOS (LEAD TECH) |
| Authorized Official Telephone | 7572782150 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 008528039 | 05 |
| Other Name | Type Code |
|---|---|
| Atrium Pharmacy | Doing Business As Name - Organization |
| Street Address |
155 KINGSLEY LN STE 125 |
| City | NORFOLK |
| State | VA |
| Zip Code | 23505-4629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154844256 | Cassandra Shelton | Specialist/Technologist, Other | 100 Kingsley Lane, Norfolk, VA 23505 | 2017-07-20 |
| 1063942852 | Gabriela Marie Santiago | Specialist/Technologist | 7600 Victory Dr, Apt 3, Norfolk, VA 23505 | 2017-06-14 |
| 1144776725 | Amr Hassan | Pharmacist | 1610 W Little Creek Rd, Apt 204, Norfolk, VA 23505 | 2016-09-01 |
| 1992175095 | Heather Mitchell | Nurse Practitioner | 110 Kingsley Ln Ste 309, Norfolk, VA 23505 | 2015-10-01 |
| 1255710620 | Jessica Ann Kestranek | Dentist | 7400 Granby St Ste D, Norfolk, VA 23505 | 2015-05-19 |
| 1710375274 | Carla Toledo | Nurse Practitioner | 155 Kingsley Lane, Suite 400, Norfolk, VA 23505 | 2015-01-06 |
| 1417359746 | James Austin Valone Jr. | Ophthalmology | 1423 Runymede Rd, Norfolk, VA 23505 | 2014-09-18 |
| 1861813370 | Harris Teeter, LLC | Pharmacy | 7550 Granby Street, Norfolk, VA 23505 | 2013-12-31 |
| 1649549361 | Linda Horsey | Social Worker | 7510 Granby Street, Suite 6, Norfolk, VA 23505 | 2011-12-27 |
| 1679705164 | Carolyn Lee Kee | Nurse's Aide | 7403 Hampton Blvd, Norfolk, VA 23505 | 2009-08-17 |
| Find all providers in zip 23505 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215578901 | Jtj Medical Supply, Inc. | Pharmacy | 1001 Monticello Ave, Norfolk, VA 23510-2564 | 2019-10-03 |
| 1861813370 | Harris Teeter, LLC | Pharmacy | 7550 Granby Street, Norfolk, VA 23505 | 2013-12-31 |
| 1487959342 | Harris Teeter, LLC | Pharmacy | 1320 Colonial Avenue, Norfolk, VA 23517 | 2011-01-24 |
| 1821233040 | Wal-mart Stores East Lp | Pharmacy | 1720 E Little Creek Rd, Norfolk, VA 23518-4202 | 2008-12-03 |
| 1073623609 | Costco Wholesale Corporation | Pharmacy | 850 Glenrock Rd, Norfolk, VA 23502 | 2006-08-30 |
| 1639184682 | Walgreen Co | Pharmacy | 810 W 21st St, Norfolk, VA 23517-1514 | 2006-07-29 |
| 1093720047 | Walgreen Co | Pharmacy | 8609 Tidewater Dr, Norfolk, VA 23503-5415 | 2006-07-29 |
| 1720093776 | Walgreen Co | Pharmacy | 1169 N Military Hwy, Norfolk, VA 23502-2434 | 2006-07-29 |
| 1912912965 | Walgreen Co | Pharmacy | 115 W Little Creek Rd, Norfolk, VA 23505-2512 | 2006-07-29 |
| 1568477511 | Walgreen Co | Pharmacy | 2232 E Little Creek Rd, Norfolk, VA 23518-4221 | 2006-07-29 |
| Find all providers in NORFOLK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.