Healthcare Provider Details

I. General information

NPI: 1144683582
Provider Name (Legal Business Name): JAMES C OLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 04/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7438 MAIN ST W
WEBSTER WI
54893-8206
US

IV. Provider business mailing address

PO BOX 26
WEBSTER WI
54893-0026
US

V. Phone/Fax

Practice location:
  • Phone: 715-866-8644
  • Fax: 715-866-7344
Mailing address:
  • Phone: 715-866-8644
  • Fax: 715-866-7344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8256-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: