Organization
TIDWELL PHARMACY
Active
Other names
TIDWELL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RAVISHANKER MALLAPURAM (OWNER)
(713) 884-8807
Entity
Organization
Contact information
Practice address
12280 BROADWAY ST BLDG 4 UNIT 4124, PEARLAND, TX 77584-4352
(713) 884-8807
(713) 884-8824
Mailing address
12280 BROADWAY ST BLDG 4 UNIT 4124, PEARLAND, TX 77584-4352
(713) 884-8807
(844) 926-0468
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
23350
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145439
—
TX
01
—
2095669
PK
—
Enumeration date
02/27/2007
Last updated
10/11/2024
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