Provider Demographics
NPI:1649382631
Name:TDS INC
Entity Type:Organization
Organization Name:TDS INC
Other - Org Name:NORWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
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:906-774-2841
Mailing Address - Fax:906-774-3015
Practice Address - Street 1:514 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870-1238
Practice Address - Country:US
Practice Address - Phone:906-563-5151
Practice Address - Fax:906-563-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MI53010052523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2040998OtherPK
WI33169900Medicaid
MI2347107Medicaid
MI0265420003Medicare NSC
WI33169900Medicaid