1184695777 NPI number — TDS PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184695777 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:
1184695777
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:
3090 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48453-1279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-635-0266
Provider Business Practice Location Address Fax Number:
989-635-3801
Provider Enumeration Date:
01/31/2006

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:
810-989-1340

Provider Taxonomy Codes

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

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

  • Identifier: 2858916 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".