Provider Demographics
NPI:1821492745
Name:TIDALHEALTH HOME SCRIPTS MILLSBORO
Entity Type:Organization
Organization Name:TIDALHEALTH HOME SCRIPTS MILLSBORO
Other - Org Name:PRMC HOME SCRIPTS MILLSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULATORY PHCY MGR, PIC
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:410-543-7047
Mailing Address - Street 1:30265 COMMERCE DR
Mailing Address - Street 2:SUITE 106 A
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-3593
Mailing Address - Country:US
Mailing Address - Phone:302-297-2596
Mailing Address - Fax:302-297-2597
Practice Address - Street 1:30265 COMMERCE DR
Practice Address - Street 2:SUITE 106 A
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3593
Practice Address - Country:US
Practice Address - Phone:302-297-2596
Practice Address - Fax:302-297-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA3-00009813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151265OtherPK