Provider Demographics
NPI:1245643543
Name:STALCUP, NOAH JAMES
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:JAMES
Last Name:STALCUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8606
Mailing Address - Country:US
Mailing Address - Phone:330-244-1042
Mailing Address - Fax:330-244-1048
Practice Address - Street 1:1664 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8606
Practice Address - Country:US
Practice Address - Phone:330-244-1042
Practice Address - Fax:330-244-1048
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist