{"npi":"1285069617","type":"NPI-2","status":"active","name":{"display":"Tidalhealth Peninsula Regional, Inc.","other":[],"organization_name":"TIDALHEALTH PENINSULA REGIONAL, INC.","authorised_official":"Kevin Johnson"},"specialty":{"primary_taxonomy":"3336C0003X","primary_taxonomy_description":"Community/Retail Pharmacy","slug":"community-retail-pharmacy","schema_org_specialty":null,"all":[{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":true,"state":"MD","license":"P06040"}]},"addresses":[{"purpose":"LOCATION","street_1":"100 E CARROLL ST","city":"SALISBURY","state":"MD","postal_code":"218015422","country_code":"US","phone":"4105434798","fax":"4105434799"},{"purpose":"MAILING","street_1":"100 E CARROLL ST STE 1492","city":"SALISBURY","state":"MD","postal_code":"218015422","country_code":"US","phone":"4105434798","fax":"4105434799"}],"license":{"state":"MD","number":"P06040"},"identifiers":[{"type_code":"01","label":"Other","value":"2142289","state":null,"issuer":"PK"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20180328002816","type_code":"12-73","type_desc":"PART B SUPPLIER - MASS IMMUNIZATION (ROSTER BILLER ONLY)","state":"MD","pac_id":"3072509702"},{"enrlmt_id":"O20180505000152","type_code":"30-A5","type_desc":"DME SUPPLIER - PHARMACY","state":"MD","pac_id":"3072509702"}]},"enumeration_date":"2013-09-04","last_updated":"2026-03-02","_meta":{"source":"NPPES","snapshot_date":"2026-03-02","doc_url":"https://findmynpi.com/api"}}