Provider Demographics
NPI:1073771002
Name:TDS PHARMACY, INC.
Entity Type:Organization
Organization Name:TDS PHARMACY, INC.
Other - Org Name:SHELDON MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-989-1340
Mailing Address - Street 1:21 W SANILAC RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471
Mailing Address - Country:US
Mailing Address - Phone:800-922-5101
Mailing Address - Fax:866-303-2221
Practice Address - Street 1:4482 W HOUGHTON LAKE DR
Practice Address - Street 2:UNIT 1 BLDG A
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8361
Practice Address - Country:US
Practice Address - Phone:989-422-6544
Practice Address - Fax:989-422-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICME-0132501332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0228550008Medicare NSC