| NPI | 1962896688 |
|---|---|
| Doing Business As | TIDEWATER PHARMACY & COMPOUNDING |
| Entity Type | Organization |
| Authorized Contact | CHAD STRAUGHAN Owner/Pharmacist 478-954-1178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: SC 35780) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2016-01-31 |