Provider Demographics
NPI:1720004435
Name:HIDENWOOD PHARMACY OF NEWPORT NEWS INC
Entity Type:Organization
Organization Name:HIDENWOOD PHARMACY OF NEWPORT NEWS INC
Other - Org Name:HIDENWOOD PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-595-1151
Mailing Address - Street 1:35 HIDENWOOD SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2200
Mailing Address - Country:US
Mailing Address - Phone:757-595-1151
Mailing Address - Fax:757-599-3202
Practice Address - Street 1:35 HIDENWOOD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2200
Practice Address - Country:US
Practice Address - Phone:757-595-1151
Practice Address - Fax:757-599-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010015293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008504741Medicaid
2102336OtherPK