Healthcare Provider Details

I. General information

NPI: 1578534160
Provider Name (Legal Business Name): TDS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/21/2022
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 S VAN DYKE RD
BAD AXE MI
48413-9604
US

IV. Provider business mailing address

21 W SANILAC RD
SANDUSKY MI
48471-1036
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-6460
  • Fax: 989-269-8121
Mailing address:
  • Phone: 810-648-3535
  • Fax: 810-648-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY DALE SHELDON
Title or Position: OWNER/PRESIDENT
Credential: R.PH
Phone: 810-989-1340