Healthcare Provider Details

I. General information

NPI: 1548972722
Provider Name (Legal Business Name): NOEL ZACHARIAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 LINCOLN BLVD
LINCOLN CA
95648-9389
US

IV. Provider business mailing address

1561 BELLA CIR
LINCOLN CA
95648-7918
US

V. Phone/Fax

Practice location:
  • Phone: 916-408-0810
  • Fax:
Mailing address:
  • Phone: 530-799-8049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number87076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: