NPIMap

Organization Active NPI

Tidalhealth Peninsula Regional, Inc.

Doing business as TidalHealth Specialty Pharmacy

  • Community/Retail Pharmacy
  • Salisbury, MD
National Provider Identifier
1871031559
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
TIDALHEALTH PENINSULA REGIONAL, INC.
Doing business as
TidalHealth Specialty Pharmacy
Practice address
100 E. Carroll Street
Suite 1435a
Salisbury, MD 21801
Phone
(667) 330-1065
Fax
(410) 438-1992
NPI assigned
Feb 2, 2017
Last updated
Dec 2, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
TIDALHEALTH PENINSULA REGIONAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Authorized official

Name
John JordanNPI 1306053798
Title
Sr. Director of Pharmacy
Phone
(410) 749-2825

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

100 E. Carroll Street
Suite 1435a
Salisbury, MD 21801

Mailing address

1620 W. Northwest Hwy
Suite 100
Grapevine, TX 76051
Phone (817) 572-0009

Other names 1

  • TidalHealth Specialty Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250826001552 MD DME Supplier - Pharmacy 3072509702 Practice locations: Salisbury, MD

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Peninsula Reg Med Ctr33 organizations share this tax ID, including this one
Part of
Peninsula Reg Med Ctr

Other organizations with this tax ID 32

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

View all 32

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

32335 DuPont Blvd
Dagsboro, DE 19939
Phone (302) 297-2594

10344 Old Ocean City Blvd
Berlin, MD 21811
Phone (410) 641-2938

10445 Old Ocean City Blvd
Berlin, MD 21811
Phone (410) 641-4200

10514 Racetrack Rd
Berlin, MD 21811
Phone (410) 973-2301

11101 Cathage Rd
Ste 1
Berlin, MD 21811
Phone (410) 912-6106

9952 N Main St
Berlin, MD 21811
Phone (410) 912-6008

100 E Carroll St
Ste 1435A
Salisbury, MD 21801
Phone (667) 330-1065

106 Milford St
#4
Salisbury, MD 21804
Phone (410) 543-7294

106 Milford St
Bldg 4
Salisbury, MD 21804
Phone (410) 543-7294

1201 Pemberton Dr
Ste 2B
Salisbury, MD 21801
Phone (410) 749-8300

145 E Carroll St
#A1
Salisbury, MD 21801
Phone (410) 749-1282

262 Tilghman Rd
Salisbury, MD 21804
Phone (410) 543-7188

266 Tilghman Rd
Salisbury, MD 21804
Phone (410) 543-7188

508 S Division St
Salisbury, MD 21801
Phone (410) 543-7550

800 S Salisbury Blvd
Ste D
Salisbury, MD 21801
Phone (302) 297-2412

Practitioners & affiliated clinicians

Practitioners 206

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.

View all 206

NPI Registry JSON

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

{
    "created_epoch": "1485993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1871031559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 W. NORTHWEST HWY",
            "address_2": "SUITE 100",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "76051",
            "telephone_number": "817-572-0009",
            "fax_number": "817-572-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E. CARROLL STREET",
            "address_2": "SUITE 1435A",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21801",
            "telephone_number": "667-330-1065",
            "fax_number": "410-438-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH PENINSULA REGIONAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIDALHEALTH PENINSULA REGIONAL, INC.",
        "enumeration_date": "2017-02-02",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SR. DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "410-749-2825"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TidalHealth Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; 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.