Provider Demographics
NPI:1053693952
Name:NOEL-ALCINEUS, EMMA (PHARMD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:NOEL-ALCINEUS
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 1:2501 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-5588
Mailing Address - Country:US
Mailing Address - Phone:772-595-0525
Mailing Address - Fax:772-595-0525
Practice Address - Street 1:2501 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-5588
Practice Address - Country:US
Practice Address - Phone:772-595-3077
Practice Address - Fax:772-595-0525
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639184872OtherWALGREENS