TIDEWATER PHARMACY & MEDICAL SUPPLY LLC (NPI# 1760876486) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760876486 |
| Entity Type | Organization |
| Organization Name | TIDEWATER PHARMACY & MEDICAL SUPPLY LLC |
| Other Organization Name | TIDEWATER PHARMACY & COMPOUNDING |
| Practice Address |
421 Johnnie Dodds Blvd Ste 100 Mount Pleasant SC 29464-3052 |
| Mailing 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 | 2015-03-19 |
| Last Update Date | 2016-01-31 |
| Authorized Official Name | CHAD 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 | 335E00000X | Prosthetic/Orthotic Supplier | 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 |
| 1417341132 | Tidewater Pharmacy & Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 421 Johnnie Dodds Blvd, Mount Pleasant, SC 29464 | 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 STE 100 |
| City | MOUNT PLEASANT |
| State | SC |
| Zip Code | 29464-3052 |
| 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 |
| 1417341132 | Tidewater Pharmacy & Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 421 Johnnie Dodds Blvd, Mount Pleasant, SC 29464 | 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 | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538568340 | 360 Medical | Prosthetic/Orthotic Supplier | 1011 Lake Hunter Cir, Suite 105, Mount Pleasant, SC 29464-5418 | 2014-08-18 |
| 1558502005 | 7 Sisters Care Health Boutique,inc. | Prosthetic/Orthotic Supplier | 2015 Mulberry Ave, Ste. 320, Mount Pleasant, TX 75455-2362 | 2009-03-13 |
| 1134155914 | Palmetto Ortho of Chas, Pa | Prosthetic/Orthotic Supplier | 180 Wingo Way Ste 301, Mount Pleasant, SC 29464-1812 | 2006-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366056483 | C Marie Aesthetics | Prosthetic/Orthotic Supplier | 41f Goethe Rd, Bluffton, SC 29910-6001 | 2020-09-04 |
| 1124631056 | Dynesha Thomas | Prosthetic/Orthotic Supplier | 525 3rd Loop Rd Apt H, Florence, SC 29505-4706 | 2020-08-29 |
| 1427667591 | Ashleigha Rogers | Prosthetic/Orthotic Supplier | 324 Manning Ave, Sumter, SC 29150-5763 | 2020-07-24 |
| 1285252940 | Carolina Orthotics and Prosthetics LLC | Prosthetic/Orthotic Supplier | 708 Lafayette Ave, Ste 4, Camden, SC 29020 | 2020-07-09 |
| 1427676386 | Carolina Orthotics and Prosthetics LLC | Prosthetic/Orthotic Supplier | 1108 N Jefferies Blvd, Walterboro, SC 29488-2730 | 2020-07-08 |
| 1881219616 | Glammed Studio | Prosthetic/Orthotic Supplier | 47 Bristlecone Ln, Elgin, SC 29045-9584 | 2020-06-08 |
| 1497374557 | Image Obsession LLC | Prosthetic/Orthotic Supplier | 1855 E Main St # Sr03, Spartanburg, SC 29307-2309 | 2020-04-09 |
| 1598394926 | Hair Replacement Systems and Hairstyles Usa Inc. | Prosthetic/Orthotic Supplier | 105 E Butler Rd Ste C, Mauldin, SC 29662-2100 | 2020-04-07 |
| 1851958284 | Richard A Katenhusen | Prosthetic/Orthotic Supplier | 181 Bluffton Rd Ste B104, Bluffton, SC 29910-6218 | 2019-05-21 |
| 1699261917 | Carolina Bone & Joint Pa | Prosthetic/Orthotic Supplier | 1 Wellness Blvd Ste 104, Irmo, SC 29063-2872 | 2018-07-10 |
| Find all providers with the same taxonomy | ||||
| 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.