Healthcare Provider Details

I. General information

NPI: 1043504574
Provider Name (Legal Business Name): OLLERMAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 W VILLARD ST STE 1
DICKINSON ND
58601-4656
US

IV. Provider business mailing address

1571 W VILLARD ST STE 1
DICKINSON ND
58601-4656
US

V. Phone/Fax

Practice location:
  • Phone: 701-227-8265
  • Fax: 701-227-8289
Mailing address:
  • Phone: 701-227-8265
  • Fax: 701-227-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR327
License Number StateND

VIII. Authorized Official

Name: BRANDI OLLERMAN
Title or Position: OWNER
Credential:
Phone: 701-227-8265