Provider Demographics
NPI:1568702553
Name:NOTEBOOM, NANCY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:NOTEBOOM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N IH 35
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705
Mailing Address - Country:US
Mailing Address - Phone:254-799-1182
Mailing Address - Fax:254-799-5229
Practice Address - Street 1:801 N INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2874
Practice Address - Country:US
Practice Address - Phone:254-799-1182
Practice Address - Fax:254-799-5229
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist