Provider Demographics
NPI:1487710562
Name:NOBLE, JACQUELYN SUE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:SUE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 19TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3222
Mailing Address - Country:US
Mailing Address - Phone:701-899-0033
Mailing Address - Fax:
Practice Address - Street 1:387 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4677
Practice Address - Country:US
Practice Address - Phone:701-642-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist