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General NPI Number Information
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NPI Number | 1730800632
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Entity Type | Individual
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Provider Name | MATTHEW NOARK
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Gender | Male
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 3080 W KELLY PARK RD
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City | APOPKA
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State | FL
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Zip | 32712-5193
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Country | US
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Telephone | 407-553-4516
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Fax |
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Provider Business Mailing Address
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Address Line | 6067 FALLS HOLLOW DR
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City | BROOKSVILLE
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State | FL
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Zip | 34601-7700
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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 | PS64819
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License Number State | FL
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