Tidalhealth Peninsula Regional, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P06935 Issued in MD

Legal business name

TIDALHEALTH PENINSULA REGIONAL, INC.

Practice address

11101 Cathage Rd
Berlin, MD 21811

Phone

(410) 543-4769

Fax

(410) 543-4770

NPI assigned

Oct 17, 2014

Organization subpart

No

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

Authorized official

Name

Kevin J Johnson

Title

Director of Ambulatory Pharmacy SVC

Phone

(410) 543-7745

Specialties & licenses 1

Addresses

Other identifiers 1

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.

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

  O20180328002816

  Same enrollment

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153648",
            "state": null
        }
    ],
    "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 Atlantic, Inc.
• Tidalhealth Atlantic, Inc.
• Tidalhealth Atlantic, Inc.
• Tidalhealth Peninsula Regional, Inc.
• Tidalhealth Physician Network, Inc.
• Tidalhealth Primary Care, LLC
• Tidalhealth Primary Care, LLC
• Tidalhealth Primary Care, LLC
• Tidalhealth Primary Care, LLC

• All providers in Berlin, MD
• 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.