Organization
TIDWELL PHARMACY
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up