Provider Demographics
NPI:1043353782
Name:NOON, BRADLEY JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:JOHN
Last Name:NOON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:5300 BONASA DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8153
Mailing Address - Country:US
Mailing Address - Phone:616-581-0281
Mailing Address - Fax:616-581-0281
Practice Address - Street 1:100 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4526
Practice Address - Country:US
Practice Address - Phone:616-965-8278
Practice Address - Fax:616-940-5805
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5302029818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302029818OtherR.PH. LICENSE