Provider Demographics
NPI:1902188956
Name:COLLEY, TARA NOBLIN (RPH)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:NOBLIN
Last Name:COLLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1108
Mailing Address - Country:US
Mailing Address - Phone:405-330-3742
Mailing Address - Fax:405-330-5700
Practice Address - Street 1:15100 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1108
Practice Address - Country:US
Practice Address - Phone:405-330-3742
Practice Address - Fax:405-330-5700
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist