TIDEWATER PHARMACY & MEDICAL SUPPLY LLC (NPI# 1639562945) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639562945 |
| Entity Type | Organization |
| Organization Name | TIDEWATER PHARMACY & MEDICAL SUPPLY LLC |
| Practice Address |
421 Johnnie Dodds Blvd Ste 100 Mount Pleasant SC 29464-2689 |
| Practice Telephone | 8433756310 |
| Practice Fax Number | 8433756311 |
| Mailing Telephone | 8433756310 |
| Mailing Fax Number | 8433756311 |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2016-01-31 |
| Authorized Official Name | CHAD LOUIS STRAUGHAN (OWNER/PHARMACIST) |
| Authorized Official Telephone | 8433756310 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
35780 | SC | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417316548 | Tidewater Pharmacy & Medical Supply LLC | Pharmacy | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464-3052 | 2016-02-17 |
| 1962896688 | Tidewater Pharmacy & Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464 | 2015-03-19 |
| 1053705772 | Tidewater Pharmacy & Medical Supply LLC | Pharmacy | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464 | 2015-03-19 |
| 1760876486 | Tidewater Pharmacy & Medical Supply LLC | Prosthetic/Orthotic Supplier | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464-3052 | 2015-03-19 |
| 1417341132 | Tidewater Pharmacy & Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 421 Johnnie Dodds Blvd, Mount Pleasant, SC 29464 | 2015-03-19 |
| Street Address |
421 JOHNNIE DODDS BLVD STE 100 |
| City | MOUNT PLEASANT |
| State | SC |
| Zip Code | 29464-2689 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255749131 | Chad Louis Straughan | Pharmacist | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464-2689 | 2014-07-23 |
| 1487252045 | Heather D Quinn | Pharmacist | 421 Johnnie Dodds Blvd, Mount Pleasant, SC 29464-3052 | 2020-10-15 |
| 1417316548 | Tidewater Pharmacy & Medical Supply LLC | Pharmacy | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464-3052 | 2016-02-17 |
| 1962896688 | Tidewater Pharmacy & Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464 | 2015-03-19 |
| 1053705772 | Tidewater Pharmacy & Medical Supply LLC | Pharmacy | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464 | 2015-03-19 |
| 1760876486 | Tidewater Pharmacy & Medical Supply LLC | Prosthetic/Orthotic Supplier | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464-3052 | 2015-03-19 |
| 1417341132 | Tidewater Pharmacy & Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 421 Johnnie Dodds Blvd, Mount Pleasant, SC 29464 | 2015-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811548241 | Bradley Paul Anuszkiewicz | Chiropractor | 1501 Johnnie Dodds Blvd, Suite C, Mount Pleasant, SC 29464 | 2019-09-26 |
| 1447808696 | Laura Mariah Crouse | Speech-Language Pathologist | Coastal Therapy Services, 1127 Queensborough Blvd, Mt Pleasant, SC 29464 | 2019-08-30 |
| 1912461807 | Independent Optical | Optometrist | 1710 Shoremead Rd, Suite 420, Mount Pleasant, SC 29464 | 2019-01-25 |
| 1417446204 | Michael Adam Sugarman | Clinical Neuropsychologist | 1459 Stuart Engals Blvd Ste 204a, Mt Pleasant, SC 29464 | 2018-05-07 |
| 1578064192 | Ancillary Specialists LLC | Durable Medical Equipment & Medical Supplies | 636 Long Point Road, Unit G, #19, Mount Pleasant, SC 29464 | 2018-02-28 |
| 1346769015 | Christin Solomon Zerega | Counselor | Lowcountry Psychiatry Group, 913 Bowman Rd, #4, Mount Pleasant, SC 29464 | 2017-09-14 |
| 1336660315 | Charleston Neuropsychology LLC | Psychologist | 1459 Stuart Engals Blvd., Suite 204a, Mount Pleasant, SC 29464 | 2017-06-29 |
| 1790219970 | Adam Hudepohl | Family Medicine | 1400 Ben Sawyer Blvd, Mt Pleasant, SC 29464 | 2017-04-14 |
| 1386181204 | Alicia Taylor | Speech-Language Pathologist | 381 Stonewall Ct Apt 6207, Mount Pleasant, SC 29464 | 2017-01-30 |
| 1285181941 | Tara Lynn Mast | Physical Therapist | 1400 Caliper Oak Circle, Apt 316, Mount Pleasant, SC 29464 | 2016-09-09 |
| Find all providers in zip 29464 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851939037 | Ascension Wisconsin Pharmacy, Inc | Pharmacy | 10180 Washington Ave Ste 102, Mount Pleasant, WI 53177-1604 | 2019-12-18 |
| 1285027391 | Ron Group | Pharmacy | 570 Long Point Rd Ste 170, Mount Pleasant, SC 29464-7931 | 2015-03-13 |
| 1285912394 | Roundys Supermarkets Inc | Pharmacy | 2820 S Green Bay Rd, Mount Pleasant, WI 53406-4950 | 2011-07-25 |
| 1396981239 | Moose Drug Company | Pharmacy | 8374 West Franklin Street, Mount Pleasant, NC 28124-0067 | 2008-12-24 |
| 1922257609 | Saginaw Chippewa Indian Tribe | Pharmacy | 2410 S Leaton Rd, Ste 8, Mount Pleasant, MI 48858-8639 | 2008-09-17 |
| 1548277585 | Walgreen Co | Pharmacy | 6125 Durand Ave, Mount Pleasant, WI 53406-4913 | 2006-08-02 |
| 1114442860 | Walgreen Co | Pharmacy | 1799 N Highway 17, Mount Pleasant, SC 29464 | 2017-08-03 |
| 1518321926 | Raven Holdings, LLC | Pharmacy | 953 Houston Northcutt Blvd, Mount Pleasant, SC 29464-3468 | 2016-04-12 |
| 1619375839 | Walgreen Co | Pharmacy | 389 Johnnie Dodds Blvd, Mount Pleasant, SC 29464-2932 | 2014-12-22 |
| 1194092932 | Walgreen | Pharmacy | 4901 Spring St, Mount Pleasant, WI 53406-2901 | 2011-11-22 |
| Find all providers in MOUNT PLEASANT | ||||
| City | MOUNT PLEASANT |
| Zip Code | 29464 |
Please comment or provide details below to improve the information on TIDEWATER PHARMACY & MEDICAL SUPPLY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.