Provider Demographics
NPI:1568776797
Name:DHAMODIWALA, PERCY (RPH)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:
Last Name:DHAMODIWALA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20560 COURTNEY WAY
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4862
Mailing Address - Country:US
Mailing Address - Phone:302-362-9297
Mailing Address - Fax:
Practice Address - Street 1:32362 LONG NECK RD UNIT 5
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-9062
Practice Address - Country:US
Practice Address - Phone:302-362-9297
Practice Address - Fax:302-947-0555
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16798183500000X
DEA1-0004110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist