Organization
CHARLES M TIDWELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MICHAEL TIDWELL RPH (PHARMACIST)
(951) 637-7054
Entity
Organization
Contact information
Practice address
3975 JACKSON ST STE 111, RIVERSIDE, CA 92503-3946
(951) 637-7054
(951) 637-7056
Mailing address
3975 JACKSON ST STE 111, RIVERSIDE, CA 92503-3946
(951) 637-7054
(951) 637-7056
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
38762
CA
Other
Enumeration date
10/14/2015
Last updated
10/14/2015
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