Healthcare Provider Details

I. General information

NPI: 1255449823
Provider Name (Legal Business Name): BRIAN ROGER OLSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N HWY 51
POYNETTE WI
53955
US

IV. Provider business mailing address

5009 MIRANDY ROSE CT
MIDDLETON WI
53562-2386
US

V. Phone/Fax

Practice location:
  • Phone: 608-635-9456
  • Fax:
Mailing address:
  • Phone: 608-833-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7827-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: