MEDICARE: NOBLE CARE APOTHECARY 2

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1447140306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLE CARE APOTHECARY 2

Provider Business Mailing Address
First Line	:	2900 UNION LAKE RD STE 213
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48382-3526
Country	:	US
Telephone Number	:	947-267-2455
Fax Number	:	947-252-7373

Provider Business Practice Location Address
First Line	:	2900 UNION LAKE RD STE 213
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-3526
Country	:	US
Telephone Number	:	248-461-6509
Fax Number	:	248-599-9266

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE/OWNER
Name	:	DR. SHATHA MATTI
Credential	:	PHARMD
Telephone Number	:	947-267-2455

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	12/08/2025

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