Healthcare Provider Details

I. General information

NPI: 1558117077
Provider Name (Legal Business Name): NOBLE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 POMONA DR
GREENSBORO NC
27407-1693
US

IV. Provider business mailing address

6040 TARBELL RD
SYRACUSE NY
13206-1314
US

V. Phone/Fax

Practice location:
  • Phone: 888-743-3204
  • Fax: 743-242-1462
Mailing address:
  • Phone: 888-843-2040
  • Fax: 888-842-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DUTEAU
Title or Position: PRESIDENT
Credential:
Phone: 888-843-2040