Organization
TIDEWATER PHARMACY & MEDICAL SUPPLY LLC
Active
Other names
Tidewater Pharmacy & Compounding
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD LOUIS STRAUGHAN PHARMD (OWNER/PHARMACIST)
(842) 375-6310
Entity
Organization
Contact information
Practice address
421 JOHNNIE DODDS BLVD, STE 100, MOUNT PLEASANT, SC 29464-3052
(843) 375-6310
(843) 375-6311
Mailing address
421 JOHNNIE DODDS BLVD, STE 100, MOUNT PLEASANT, SC 29464-3052
(843) 375-6310
(843) 375-6311
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
Primary
15890
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
715890
—
SC
Enumeration date
02/17/2016
Last updated
02/17/2016
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