Provider Demographics
NPI:1114629227
Name:TIDALHEALTH NANTICOKE, INC
Entity Type:Organization
Organization Name:TIDALHEALTH NANTICOKE, INC
Other - Org Name:TIDALHEALTH HOME SCRIPTS NANTICOKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:W
Authorized Official - Last Name:JESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-297-2420
Mailing Address - Street 1:801 MIDDLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3636
Mailing Address - Country:US
Mailing Address - Phone:302-297-2420
Mailing Address - Fax:
Practice Address - Street 1:801 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3636
Practice Address - Country:US
Practice Address - Phone:302-297-2420
Practice Address - Fax:302-297-2421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy