Provider Demographics
NPI:1598947533
Name:NOBLE, STUART MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:MICHAEL
Last Name:NOBLE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N MAIN AVE
Mailing Address - Street 2:PO BOX 848
Mailing Address - City:BAUDETTE
Mailing Address - State:MN
Mailing Address - Zip Code:56623-2466
Mailing Address - Country:US
Mailing Address - Phone:218-634-1236
Mailing Address - Fax:218-634-1276
Practice Address - Street 1:111 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623-2466
Practice Address - Country:US
Practice Address - Phone:218-634-1236
Practice Address - Fax:218-634-1276
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114388-5183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist