Provider Demographics
NPI:1598442949
Name:NOODLES, INC
Entity Type:Organization
Organization Name:NOODLES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRAEFF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:971-601-0551
Mailing Address - Street 1:95 S COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-4051
Mailing Address - Country:US
Mailing Address - Phone:971-601-0551
Mailing Address - Fax:
Practice Address - Street 1:95 S COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138-4051
Practice Address - Country:US
Practice Address - Phone:971-601-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOODLES, INC., DBA MIKE'S COMPOUNDING APOTHECARY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy