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General NPI Number Information
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NPI Number | 1578299640
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Entity Type | Individual
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Provider Name | NOAH PACK
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Gender | Male
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 7045 LIGHTHOUSE WAY
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City | PERRYSBURG
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State | OH
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Zip | 43551-7000
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Country | US
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Telephone | 419-873-6836
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Fax |
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Provider Business Mailing Address
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Address Line | 7553 STONECLIFFE DR
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City | MAUMEE
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State | OH
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Zip | 43537-8729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03442313
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License Number State | OH
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