Provider Demographics
NPI:1548972722
Name:ZACHARIAH, NOEL
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:ZACHARIAH
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 1:1561 BELLA CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7918
Mailing Address - Country:US
Mailing Address - Phone:530-799-8049
Mailing Address - Fax:
Practice Address - Street 1:67 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-9389
Practice Address - Country:US
Practice Address - Phone:916-408-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA870763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy