Provider Demographics
NPI:1114631447
Name:TSI TIDEWATER LLC
Entity Type:Organization
Organization Name:TSI TIDEWATER LLC
Other - Org Name:VITAL CARE OF SUFFOLK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PHARMACISTS
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACISTS
Authorized Official - Phone:757-861-0050
Mailing Address - Street 1:1520 BREEZEPORT WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3757
Mailing Address - Country:US
Mailing Address - Phone:757-861-0050
Mailing Address - Fax:757-335-7354
Practice Address - Street 1:1520 BREEZEPORT WAY STE 500
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3757
Practice Address - Country:US
Practice Address - Phone:757-861-0050
Practice Address - Fax:757-335-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy