Provider Demographics
NPI:1023450129
Name:MCBROOM, NOAH (PHARMD)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:MCBROOM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 38TH ST NW # UNITSDEF
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2953
Mailing Address - Country:US
Mailing Address - Phone:866-903-5720
Mailing Address - Fax:
Practice Address - Street 1:706 38TH ST NW # UNITSDEF
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2953
Practice Address - Country:US
Practice Address - Phone:701-893-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5559183500000X
MN121223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist