Healthcare Provider Details

I. General information

NPI: 1841892452
Provider Name (Legal Business Name): SCOTT THOMAS SAMPLES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AI DUPONT A HOSPITAL FOR CHILDREN 1600 ROCKLAND ROAD
WILMINGTON DE
19803-3607
US

IV. Provider business mailing address

2208 BAYNARD BLVD
WILMINGTON DE
19802-3939
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-5702
  • Fax:
Mailing address:
  • Phone: 302-571-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberA1-0002004
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: