Provider Demographics
NPI:1740889450
Name:NOONAN, PATRICK MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:NOONAN
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 1:4428 LYNNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1037
Mailing Address - Country:US
Mailing Address - Phone:502-905-8719
Mailing Address - Fax:
Practice Address - Street 1:4211 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1619
Practice Address - Country:US
Practice Address - Phone:502-363-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist