| NPI | 1053705772 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2015-03-19 |
| Last Updated | 2016-01-31 |
| Authorized Official | Chad Straughan Owner/Pharmacist Phone: 8433756310 |
| Mailing Address | 421 Johnnie Dodds Blvd, Ste 100 Mount Pleasant, SC 29464-3052 United States Phone: (478) 954-1178 | Fax: (843) 375-6311 📍 View Map |
| Primary Practice Address | 421 Johnnie Dodds Blvd, Ste 100 Mount Pleasant, SC 29464 United States Phone: (843) 375-6310 | Fax: (843) 375-6311 📍 View Map |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| Yes | 3336C0004X – Pharmacy, Compounding Pharmacy | SC | 35780 |
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About NPI 1053705772
Tidewater Pharmacy & Medical Supply Llc is an organization registered in the CMS NPPES NPI Registry with NPI number 1053705772. The primary specialty listed is Pharmacy, Compounding Pharmacy. The organization is located in Mount Pleasant, SC. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2015-03-19. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1053705772?
NPI 1053705772 belongs to Tidewater Pharmacy & Medical Supply Llc, a Pharmacy, Compounding Pharmacy in Mount Pleasant, SC. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1053705772 active?
The current status of NPI 1053705772 in the NPPES registry is Active. The record was last updated on 2016-01-31.
What specialty is NPI 1053705772?
NPI 1053705772 is classified under the taxonomy Pharmacy, Compounding Pharmacy. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1053705772?
You can verify NPI 1053705772 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1053705772?
The primary practice address on file for NPI 1053705772 is 421 Johnnie Dodds Blvd, Mount Pleasant, SC 29464. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1053705772 issued?
NPI 1053705772 was first issued (enumerated) on 2015-03-19. The NPPES record was last updated on 2016-01-31.
Practice Location Map
Tidewater Pharmacy & Medical Supply Llc is located at 421 Johnnie Dodds Blvd, Mount Pleasant, SC. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Tidewater Pharmacy & Medical Supply Llc. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1053705772. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Pharmacy, Compounding Pharmacy | 35780 | SC |