Healthcare Provider Details

I. General information

NPI: 1992086789
Provider Name (Legal Business Name): MARK H NOBLE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 N EL PASO ST
COLORADO SPRINGS CO
80907-7105
US

IV. Provider business mailing address

2010 N EL PASO ST
COLORADO SPRINGS CO
80907-7105
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-7434
  • Fax:
Mailing address:
  • Phone: 719-471-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9688
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: