| Organization Name: | TIDEWATER PHARMACY & MEDICAL SUPPLY LLC |
| NPI Number: | 1417341132 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHAD STRAUGHAN (OWNER/PHARMACIST) |
| Mailing Address: | 421 Johnnie Dodds Blvd Mount Pleasant |
| State: | SC US |
| Postal Code: | 29464 |
| Phone Number: | 8433756310 |
| Fax Number: | 8433756311 |
| NPI Enumeration Date: | 03/19/2015 |
| NPI Last Update Date: | 02/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 35780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |