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General NPI Number Information
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NPI Number | 1225506819
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Entity Type | Organization
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Legal Business Name | TDS, INC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 1112 S STEPHENSON AVE
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-4038
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Country | US
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Telephone | 906-774-3654
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-0189
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | STEPHEN ROELL
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Credential |
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Telephone | 906-774-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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