Provider Demographics
NPI:1861590192
Name:NOBLE PHARMACY MT CO
Entity type:Organization
Organization Name:NOBLE PHARMACY MT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAIF
Authorized Official - Middle Name:M
Authorized Official - Last Name:TITI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-604-5811
Mailing Address - Street 1:47 TONNELE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5412
Mailing Address - Country:US
Mailing Address - Phone:201-604-5811
Mailing Address - Fax:201-604-5815
Practice Address - Street 1:47 TONNELE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5412
Practice Address - Country:US
Practice Address - Phone:201-604-5811
Practice Address - Fax:201-604-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ003347003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4201320001Medicare ID - Type UnspecifiedPHARMACY