Provider Demographics
NPI:1437230539
Name:TIDWELL, JARROD ALLEN (PHARM D)
Entity type:Individual
Prefix:MR
First Name:JARROD
Middle Name:ALLEN
Last Name:TIDWELL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:FL
Mailing Address - Zip Code:32445-0085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12890 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AL
Practice Address - Zip Code:36320-4293
Practice Address - Country:US
Practice Address - Phone:334-691-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist