TIDEWATER PHARMACY & MEDICAL SUPPLY LLC (NPI# 1417341132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417341132 |
| Entity Type | Organization |
| Organization Name | TIDEWATER PHARMACY & MEDICAL SUPPLY LLC |
| Other Organization Name | TIDEWATER PHARMACY & COMPOUNDING |
| Practice Address |
421 Johnnie Dodds Blvd Mount Pleasant SC 29464 |
| Mailing Address |
421 Johnnie Dodds Blvd Ste 100 Mount Pleasant SC 29464-2689 |
| Practice Telephone | 8433756310 |
| Practice Fax Number | 8433756311 |
| Mailing Telephone | 4789541178 |
| Mailing Fax Number | 8433756311 |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2016-02-11 |
| Authorized Official Name | CHAD STRAUGHAN (OWNER/PHARMACIST) |
| Authorized Official Telephone | 4789541178 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | 35780 | SC | Suppliers |
| Other Name | Type Code |
|---|---|
| Tidewater Pharmacy & Compounding | Doing Business As Name - Organization |
| 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 |
| 1639562945 | Tidewater Pharmacy & Medical Supply LLC | Pharmacy | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464-2689 | 2015-03-11 |
| Street Address |
421 JOHNNIE DODDS BLVD |
| City | MOUNT PLEASANT |
| State | SC |
| Zip Code | 29464 |
| 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 |
| 1639562945 | Tidewater Pharmacy & Medical Supply LLC | Pharmacy | 421 Johnnie Dodds Blvd, Ste 100, Mount Pleasant, SC 29464-2689 | 2015-03-11 |
| 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 | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609402296 | Shawn Pinkston | Durable Medical Equipment & Medical Supplies | 856 Lowcountry Blvd Ste 101, Mount Pleasant, SC 29464-3181 | 2020-03-16 |
| 1174175038 | South Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 225 Faison Rd, Mount Pleasant, SC 29466 | 2019-07-11 |
| 1679037493 | Michael Kirkland Purcell | Durable Medical Equipment & Medical Supplies | 55 Hopetown Rd, Mount Pleasant, SC 29464-6662 | 2019-01-25 |
| 1578064192 | Ancillary Specialists LLC | Durable Medical Equipment & Medical Supplies | 636 Long Point Road, Unit G, #19, Mount Pleasant, SC 29464 | 2018-02-28 |
| 1790227502 | Prime Care Dme LLC | Durable Medical Equipment & Medical Supplies | 515 N Mission St, Mount Pleasant, MI 48858-1827 | 2016-11-10 |
| 1881021582 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 1981 Riviera Drive, Mount Pleasant, SC 29464-7401 | 2013-09-26 |
| 1689015356 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 5625 Washington Ave, Mount Pleasant, WI 53406-4015 | 2013-07-10 |
| 1003160458 | Tina Bowlin | Durable Medical Equipment & Medical Supplies | 947 Myrtle Ct, Mount Pleasant, SC 29464-4526 | 2012-11-07 |
| 1114203973 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 2903 N Highway 17, Mount Pleasant, SC 29466 | 2011-10-25 |
| 1528362639 | American Dme and Medical Supply, Inc. | Durable Medical Equipment & Medical Supplies | 1107 S Mission St, Mount Pleasant, MI 48858-3914 | 2011-01-04 |
| 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.