Provider Demographics
NPI:1861092231
Name:NOLAND, JAMES IV
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:NOLAND
Suffix:IV
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 1:2804 AVENUE OF THE WOODS
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6232
Mailing Address - Country:US
Mailing Address - Phone:270-312-4637
Mailing Address - Fax:
Practice Address - Street 1:100 WALMART DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5548
Practice Address - Country:US
Practice Address - Phone:270-769-3825
Practice Address - Fax:270-737-1943
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist