Provider Demographics
NPI:1063122000
Name:CRESCO, NOAH THOMAS (PHARMD, MBA)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:THOMAS
Last Name:CRESCO
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 N DODGE ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:319-337-6310
Mailing Address - Fax:319-337-2037
Practice Address - Street 1:1125 N DODGE ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-337-6310
Practice Address - Fax:319-337-2037
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03442739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist