NPIMap

Organization Active NPI

Tidalhealth Atlantic, Inc.

Doing business as TidalHealth Community Pharmacy

  • Pharmacy
  • Berlin, MD
National Provider Identifier
1003227729
Registry record updated Mar 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
P06310 Issued in MD
Legal business name
TIDALHEALTH ATLANTIC, INC.
Doing business as
TidalHealth Community Pharmacy
Practice address
9733 Healthway Dr
Berlin, MD 21811-1155
Phone
(410) 641-9727
Fax
(410) 641-9750
NPI assigned
May 15, 2014
Last updated
Mar 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie Gary
Title
SVP, Finance/Cfo of Tidalhealth
Phone
(410) 912-6059

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X P06310 MD Primary

Addresses

Primary practice location

9733 Healthway Dr
Berlin, MD 21811-1155

Mailing address

9733 Healthway Dr
Berlin, MD 21811-1155
Phone (410) 641-9240

Other names 3

  • TidalHealth Community Pharmacy Doing business as
  • Atlantic General Hospital Corporation Former legal business name
  • AGH RediScripts Pharmacy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160812000402 MD Part B Supplier - Mass Immunization (Roster Biller Only) 2365437837 Practice locations: Berlin, MD
O20160818000130 MD Part B Supplier - Pharmacy 2365437837 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Berlin, MD

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Atlantic General Hospital35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773187200000",
    "number": "1003227729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9733 HEALTHWAY DR",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111155",
            "telephone_number": "410-641-9240",
            "fax_number": "410-641-9246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9733 HEALTHWAY DR",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111155",
            "telephone_number": "410-641-9727",
            "fax_number": "410-641-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH ATLANTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-15",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A",
        "authorized_official_last_name": "GARY",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "SVP, FINANCE/CFO OF TIDALHEALTH",
        "authorized_official_telephone_number": "410-912-6059"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MD",
            "license": "P06310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TidalHealth Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Atlantic General Hospital Corporation",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "AGH RediScripts Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Berlin, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.