Provider Demographics
NPI:1053868323
Name:ETUBE, NOELLE DARE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:DARE
Last Name:ETUBE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SHIPPING PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4318
Mailing Address - Country:US
Mailing Address - Phone:410-282-0020
Mailing Address - Fax:
Practice Address - Street 1:29 SHIPPING PL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-4318
Practice Address - Country:US
Practice Address - Phone:410-282-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist