Healthcare Provider Details

I. General information

NPI: 1730473091
Provider Name (Legal Business Name): DANIELLE C OLMSCHENK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE C PETERSON PHARMD

II. Dates (important events)

Enumeration Date: 06/04/2011
Last Update Date: 06/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 109TH AVE NE T-1832
BLAINE MN
55449-4670
US

IV. Provider business mailing address

1500 109TH AVE NE T-1832
BLAINE MN
55449-4670
US

V. Phone/Fax

Practice location:
  • Phone: 763-354-1001
  • Fax: 763-354-1001
Mailing address:
  • Phone: 763-354-1001
  • Fax: 763-354-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number119854
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: