Provider Demographics
NPI:1699068064
Name:DIETZ, CAROL E (RPH)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:DIETZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:WYNNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1411 JENKS CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9425
Mailing Address - Country:US
Mailing Address - Phone:919-749-8347
Mailing Address - Fax:919-303-6661
Practice Address - Street 1:2741 NC HIGHWAY 55
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-6206
Practice Address - Country:US
Practice Address - Phone:919-363-3278
Practice Address - Fax:919-303-6661
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10235183500000X
IN26015815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist