Provider Demographics
NPI:1932709375
Name:NORTON, CARLA JEAN (DPH)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JEAN
Last Name:NORTON
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 E 96TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5320
Mailing Address - Country:US
Mailing Address - Phone:918-272-1134
Mailing Address - Fax:918-272-6645
Practice Address - Street 1:12101 E 96TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5320
Practice Address - Country:US
Practice Address - Phone:918-272-1134
Practice Address - Fax:918-272-6645
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist