1629049820 NPI number — TDS PHARMACY INC

Table of content: (NPI 1629049820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629049820 NPI number — TDS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TDS PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHELDON MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629049820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 W SANILAC RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDUSKY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48471-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-648-3535
Provider Business Mailing Address Fax Number:
810-648-1896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 W SANILAC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDUSKY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48471-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-648-3535
Provider Business Practice Location Address Fax Number:
810-648-1896
Provider Enumeration Date:
01/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHELDON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
810-989-1342

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: 5301005745 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 52551 . This is a "NORTHWOOD/NPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2858916 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0984112 . This is a "HPM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540G60367 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".