Healthcare Provider Details

I. General information

NPI: 1114629227
Provider Name (Legal Business Name): TIDALHEALTH NANTICOKE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MIDDLEFORD RD
SEAFORD DE
19973-3636
US

IV. Provider business mailing address

801 MIDDLEFORD RD
SEAFORD DE
19973-3636
US

V. Phone/Fax

Practice location:
  • Phone: 302-297-2420
  • Fax: 302-297-2421
Mailing address:
  • Phone: 302-297-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENISE W JESTER
Title or Position: DIRECTOR ACCOUNTING
Credential:
Phone: 302-297-2420