Provider Demographics
NPI:1104613603
Name:TDS INC
Entity type:Organization
Organization Name:TDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:MARCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:906-774-3654
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:906-774-1044
Mailing Address - Fax:906-774-6833
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?:Yes
Parent Organization LBN:TDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy