Healthcare Provider Details

I. General information

NPI: 1992055222
Provider Name (Legal Business Name): CHRISTOPHER WILLIAM TIDMARSH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 AUGUSTA RD
PIEDMONT SC
29673
US

IV. Provider business mailing address

7501 AUGUSTA RD
PIEDMONT SC
29673
US

V. Phone/Fax

Practice location:
  • Phone: 864-299-0234
  • Fax: 864-299-3527
Mailing address:
  • Phone: 864-299-0234
  • Fax: 864-299-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13406
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: