Provider Demographics
NPI:1225506819
Name:TDS, INC
Entity Type:Organization
Organization Name:TDS, INC
Other - Org Name:THE DRUG STORE OF IRON MOUNTAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-774-1044
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1112 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4038
Practice Address - Country:US
Practice Address - Phone:906-774-3654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-13
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy