Healthcare Provider Details

I. General information

NPI: 1902238959
Provider Name (Legal Business Name): NOOR FATTOUH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD # 119
BRONX NY
10468-3904
US

IV. Provider business mailing address

130 W KINGSBRIDGE RD # 119
BRONX NY
10468-3904
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number056496-I
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number056496-I
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: