Healthcare Provider Details

I. General information

NPI: 1598947533
Provider Name (Legal Business Name): STUART MICHAEL NOBLE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2007
Last Update Date: 12/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N MAIN AVE
BAUDETTE MN
56623-2466
US

IV. Provider business mailing address

111 N MAIN AVE PO BOX 848
BAUDETTE MN
56623-2466
US

V. Phone/Fax

Practice location:
  • Phone: 218-634-1236
  • Fax: 218-634-1276
Mailing address:
  • Phone: 218-634-1236
  • Fax: 218-634-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number114388-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: