Provider Demographics
NPI:1194566984
Name:RAU, NOAH DAVID
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:DAVID
Last Name:RAU
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 1:1255 CHEROKEE TRL
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7214
Mailing Address - Country:US
Mailing Address - Phone:440-478-7488
Mailing Address - Fax:
Practice Address - Street 1:9040 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6464
Practice Address - Country:US
Practice Address - Phone:440-255-9159
Practice Address - Fax:440-255-2400
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist