Provider Demographics
NPI:1932170347
Name:NOEL PHARMACY
Entity type:Organization
Organization Name:NOEL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:319-668-1664
Mailing Address - Street 1:132 SO MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ENGLISH
Mailing Address - State:IA
Mailing Address - Zip Code:52316
Mailing Address - Country:US
Mailing Address - Phone:319-664-3115
Mailing Address - Fax:319-664-3273
Practice Address - Street 1:132 SO MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH ENGLISH
Practice Address - State:IA
Practice Address - Zip Code:52316
Practice Address - Country:US
Practice Address - Phone:319-664-3115
Practice Address - Fax:319-664-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA452333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149229Medicaid
1606928OtherNABP