Provider Demographics
NPI:1558661884
Name:NOLAN, MARLA JEAN (PHARM-D)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:JEAN
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-0056
Mailing Address - Country:US
Mailing Address - Phone:707-478-5915
Mailing Address - Fax:
Practice Address - Street 1:8 WESTMINSTER CT
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-4027
Practice Address - Country:US
Practice Address - Phone:707-478-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist