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General NPI Number Information
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NPI Number | 1821492745
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Entity Type | Organization
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Legal Business Name | TIDALHEALTH HOME SCRIPTS MILLSBORO
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 30265 COMMERCE DR SUITE 106 A
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City | MILLSBORO
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State | DE
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Zip | 19966-3593
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Country | US
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Telephone | 302-297-2596
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Fax | 302-297-2597
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Provider Business Mailing Address
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Address Line | 30265 COMMERCE DR SUITE 106 A
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City | MILLSBORO
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State | DE
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Zip | 19966-3593
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Country | US
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Telephone | 302-297-2596
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Fax | 302-297-2597
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Authorized Official
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Title or Position | AMBULATORY PHCY MGR, PIC
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Name | WILLIAM COOPER
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Credential | P.D.
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Telephone | 410-543-7047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | A3-0000981
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License Number State | DE
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