Tidalhealth Peninsula Regional, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P06935 Issued in MD

Legal business name

TIDALHEALTH PENINSULA REGIONAL, INC.

Doing business as

TidalHealth Community Pharmacy

Practice address

11101 Cathage Rd
Berlin, MD 21811

Phone

(410) 543-4769

Fax

(410) 543-4770

NPI assigned

Oct 17, 2014

Last updated

Mar 2, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin J JohnsonNPI 1023812849

Title

Director of Ambulatory Pharmacy SVC

Phone

(410) 543-7745

Specialties & licenses 1

Addresses

Other names 2

• TidalHealth Community Pharmacy Doing business as
• TidalHealth Home Scripts Other name

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Tidalhealth Peninsula Regional, Inc.

  dba TidalHealth Community Pharmacy

  • Community/Retail Pharmacy
  • Salisbury, MD
  • NPI 1285069617

  O20180328002816

  Same enrollment

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin J Johnson, PHARMD

  • Pharmacist
  • Salisbury, MD
  • NPI 1023812849
  Authorized official Same address or phone

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1851795017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11101 CATHAGE RD",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218112115",
            "telephone_number": "410-543-4769",
            "fax_number": "410-543-4770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11101 CATHAGE RD",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "21811",
            "telephone_number": "410-543-4769",
            "fax_number": "410-543-4770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH PENINSULA REGIONAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR OF AMBULATORY PHARMACY SVC",
        "authorized_official_telephone_number": "410-543-7745"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P06935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TidalHealth Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TidalHealth Home Scripts",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tidalhealth Atlantic, Inc (TidalHealth Community Pharmacy)
• Tidalhealth Atlantic, Inc. (TidalHealth Community Pharmacy)
• Tidalhealth Atlantic, Inc. (Aghrx Rediscripts Ocean Pines)
• Tidalhealth Atlantic, Inc. (AGHRx RediScripts Ocean Pines)
• Tidalhealth Peninsula Regional, Inc.
• Tidalhealth Physician Network, Inc.
• Tidalhealth Primary Care, LLC
• Tidalhealth Primary Care, LLC
• Tidalhealth Primary Care, LLC
• Tidalhealth Primary Care, LLC

• Community/Retail Pharmacy in Berlin, MD
• Providers in Berlin, MD by specialty
• Community/Retail Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.