NPIMap

Organization Active NPI

Tidewater Pharmacy & Medical Supply LLC

  • Compounding Pharmacy
  • Mount Pleasant, SC
National Provider Identifier
1053705772
Registry record updated Jan 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
License
35780 Issued in SC
Legal business name
TIDEWATER PHARMACY & MEDICAL SUPPLY LLC
Practice address
421 Johnnie Dodds Blvd
Ste 100
Mount Pleasant, SC 29464
Phone
(843) 375-6310
Fax
(843) 375-6311
NPI assigned
Mar 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2016

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

Authorized official

Name
Chad Straughan, PHARMDNPI 1255749131
Title
Owner/Pharmacist
Phone
(843) 375-6310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X 35780 SC Primary

Addresses

Primary practice location

421 Johnnie Dodds Blvd
Ste 100
Mount Pleasant, SC 29464

Mailing address

421 Johnnie Dodds Blvd
Ste 100
Mount Pleasant, SC 29464-3052
Phone (478) 954-1178

Other names 1

  • Tidewater Pharmacy & Compounding Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tidewater Pharmacy Compounding5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1426723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454198400000",
    "number": "1053705772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 JOHNNIE DODDS BLVD",
            "address_2": "STE 100",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294643052",
            "telephone_number": "478-954-1178",
            "fax_number": "843-375-6311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 JOHNNIE DODDS BLVD",
            "address_2": "STE 100",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "29464",
            "telephone_number": "843-375-6310",
            "fax_number": "843-375-6311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER PHARMACY & MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-19",
        "last_updated": "2016-01-31",
        "status": "A",
        "authorized_official_last_name": "STRAUGHAN",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "843-375-6310",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "SC",
            "license": "35780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidewater Pharmacy & Compounding",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.