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General NPI Number Information
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NPI Number | 1871031559
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Entity Type | Organization
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Legal Business Name | TIDALHEALTH PENINSULA REGIONAL, INC.
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 100 E. CARROLL STREET SUITE 1435A
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City | SALISBURY
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State | MD
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Zip | 21801
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Country | US
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Telephone | 667-330-1065
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Fax | 410-438-1992
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Provider Business Mailing Address
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Address Line | 1620 W. NORTHWEST HWY SUITE 100
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 817-572-0009
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Fax | 817-572-0221
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Authorized Official
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Title or Position | SR. DIRECTOR OF PHARMACY
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Name | JOHN JORDAN
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Credential |
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Telephone | 410-749-2825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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