Provider Demographics
NPI:1992055222
Name:TIDMARSH, CHRISTOPHER WILLIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:TIDMARSH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673
Mailing Address - Country:US
Mailing Address - Phone:864-299-0234
Mailing Address - Fax:864-299-3527
Practice Address - Street 1:7501 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673
Practice Address - Country:US
Practice Address - Phone:864-299-0234
Practice Address - Fax:864-299-3527
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist