MEDICARE: OLSON DRUG CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PH7025	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1023376	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1568468932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLSON DRUG CORPORATION

Provider Business Mailing Address
First Line	:	75 S TUTTLE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34237-6329
Country	:	US
Telephone Number	:	941-366-0090
Fax Number	:	941-954-5535

Provider Business Practice Location Address
First Line	:	75 S TUTTLE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34237-6329
Country	:	US
Telephone Number	:	941-366-0090
Fax Number	:	941-954-5535

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOUG OLSON
Credential	:	CPH
Telephone Number	:	941-366-0090

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/01/2012

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Directions to “OLSON DRUG CORPORATION ” Practice Location

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