Healthcare Provider Details

I. General information

NPI: 1336422682
Provider Name (Legal Business Name): ROBERT PATRICK TIDROW RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S MAIN ST
RED BLUFF CA
96080-4357
US

IV. Provider business mailing address

1145 S MAIN ST
RED BLUFF CA
96080-4357
US

V. Phone/Fax

Practice location:
  • Phone: 530-528-0478
  • Fax: 530-528-0481
Mailing address:
  • Phone: 530-528-0478
  • Fax: 530-528-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number38747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: