MEDICARE: MR. JARROD ALLEN TIDWELL PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS36356	FL

General Provider Information

NPI Number	:	1437230539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARROD ALLEN TIDWELL PHARM D

Provider Business Mailing Address
First Line	:	PO BOX 85
Second Line	:
City	:	MALONE
State	:	FL
Zip	:	32445-0085
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12890 COTTONWOOD RD
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320-4293
Country	:	US
Telephone Number	:	334-691-3784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/14/2022

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