{
"Npi": {
"NPI": "1821492745",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TIDALHEALTH HOME SCRIPTS MILLSBORO",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "30265 COMMERCE DR",
"SecondLineMailingAddress": "SUITE 106 A",
"MailingAddressCityName": "MILLSBORO",
"MailingAddressStateName": "DE",
"MailingAddressPostalCode": "19966-3593",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-297-2596",
"MailingAddressFaxNumber": "302-297-2597",
"FirstLinePracticeLocationAddress": "30265 COMMERCE DR",
"SecondLinePracticeLocationAddress": "SUITE 106 A",
"PracticeLocationAddressCityName": "MILLSBORO",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19966-3593",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-297-2596",
"PracticeLocationAddressFaxNumber": "302-297-2597",
"EnumerationDate": "10/21/2014",
"LastUpdateDate": "09/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COOPER",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "AMBULATORY PHCY MGR, PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.D.",
"AuthorizedOfficialTelephoneNumber": "410-543-7047",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "A3-0000981",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}