Healthcare Provider Details

I. General information

NPI: 1811256365
Provider Name (Legal Business Name): THERESA O EDIGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 SENTINEL DR
CHESAPEAKE VA
23320-4466
US

IV. Provider business mailing address

1101 E LITTLE CREEK RD
NORFOLK VA
23518-3824
US

V. Phone/Fax

Practice location:
  • Phone: 757-389-7327
  • Fax:
Mailing address:
  • Phone: 757-588-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202210785
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: