Healthcare Provider Details

I. General information

NPI: 1275763971
Provider Name (Legal Business Name): JOAN H OLSON PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOAN H BRUTCHER

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LONDON RD SUITE 101
DULUTH MN
55812-1788
US

IV. Provider business mailing address

1502 LONDON RD SUITE 101
DULUTH MN
55812-1788
US

V. Phone/Fax

Practice location:
  • Phone: 218-733-1110
  • Fax: 218-733-1112
Mailing address:
  • Phone: 218-733-1110
  • Fax: 218-733-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number720793
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: