Healthcare Provider Details

I. General information

NPI: 1801871280
Provider Name (Legal Business Name): JASON MICHAEL NOEL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WADE AVE PHARMACY DEPARTMENT
CATONSVILLE MD
21228-4663
US

IV. Provider business mailing address

20 N PINE ST S 428
BALTIMORE MD
21201-1142
US

V. Phone/Fax

Practice location:
  • Phone: 410-402-7816
  • Fax: 410-402-7990
Mailing address:
  • Phone: 410-706-7139
  • Fax: 410-706-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number15492
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: