Healthcare Provider Details

I. General information

NPI: 1851915979
Provider Name (Legal Business Name): ADAM D OLESEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 12TH ST STE 103
AUSTIN TX
78701-1955
US

IV. Provider business mailing address

313 E 12TH ST STE 103
AUSTIN TX
78701-1955
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66448
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0017394
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number66448
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: