=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285088633
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILFORD HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2016
-----------------------------------------------------
Last Update Date | 08/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 641 N DUPONT BLVD
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19963-1098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-491-6886
-----------------------------------------------------
Fax | 302-503-3352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 641 N DUPONT BLVD
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19963-1098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-491-6886
-----------------------------------------------------
Fax | 302-503-3352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | R.PH / MANAGING PARTNER
-----------------------------------------------------
Name | PERCY DHAMODIWALA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-491-6886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | A3-0001007
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------