Healthcare Provider Details

I. General information

NPI: 1699798553
Provider Name (Legal Business Name): SCOTT EDWARD OLECH R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MISSILE AVE
MINOT AFB ND
58705-5003
US

IV. Provider business mailing address

2200 BERQUIST, SUITE ONE
LACKLAND AFB TX
78236-5003
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5294
  • Fax:
Mailing address:
  • Phone: 210-292-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03219494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: