Healthcare Provider Details

I. General information

NPI: 1578830550
Provider Name (Legal Business Name): CHARLES ALBERT NOYES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 NW BEAVER ST SUITE 101
PRINEVILLE OR
97754-1802
US

IV. Provider business mailing address

159 N MAIN ST
MANTI UT
84642-1257
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-0707
  • Fax: 541-383-1883
Mailing address:
  • Phone: 435-835-3344
  • Fax: 435-835-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0014659
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: