Provider Demographics
NPI:1891021424
Name:NOLL, CAROLYN MARIE (DPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:NOLL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:FAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4602
Mailing Address - Country:US
Mailing Address - Phone:405-348-8328
Mailing Address - Fax:405-348-8439
Practice Address - Street 1:755 RESEARCH PKWY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3629
Practice Address - Country:US
Practice Address - Phone:405-330-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15045183500000X
TX39502183500000X
OK14432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist