Provider Demographics
NPI:1861272502
Name:NOEL, MONFORT ILTEUS
Entity type:Individual
Prefix:
First Name:MONFORT
Middle Name:ILTEUS
Last Name:NOEL
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 1:3 S POMPANO PKWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3001
Mailing Address - Country:US
Mailing Address - Phone:954-971-4940
Mailing Address - Fax:
Practice Address - Street 1:850 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2000
Practice Address - Country:US
Practice Address - Phone:954-785-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist