Provider Demographics
NPI:1285088633
Name:MILFORD HEALTH SERVICES LLC
Entity type:Organization
Organization Name:MILFORD HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:R.PH / MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAMODIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-491-6886
Mailing Address - Street 1:641 N DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1098
Mailing Address - Country:US
Mailing Address - Phone:302-491-6886
Mailing Address - Fax:302-503-3352
Practice Address - Street 1:641 N DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1098
Practice Address - Country:US
Practice Address - Phone:302-491-6886
Practice Address - Fax:302-503-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DEA3-00010073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159708OtherPK