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NPI Code Detail

MEDICARE: NOUH GOBENA RPH

MEDICARE: NOUH GOBENA RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist123069MN

General Provider Information

NPI Number : 1306471479
Entity Type Code : Individual
Provider Name (Legal Business Name) : NOUH GOBENA RPH
Provider Business Mailing Address
First Line : 975 COUNTY ROAD E E
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55127-7114
Country : US
Telephone Number : 651-483-2776
Fax Number :
Provider Business Practice Location Address
First Line : 975 COUNTY ROAD E E
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55127-7114
Country : US
Telephone Number : 651-483-2776
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2020
Last Update Date : 03/09/2020

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