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General NPI Number Information
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NPI Number | 1073194510
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Entity Type | Individual
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Provider Name | JAY HARVEY OLSON
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Gender | Male
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 113 N LAKE AVE
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City | BATTLE LAKE
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State | MN
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Zip | 56515-4018
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Country | US
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Telephone | 218-864-5261
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Fax | 218-864-8178
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Provider Business Mailing Address
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Address Line | PO BOX 538
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City | BATTLE LAKE
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State | MN
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Zip | 56515-0538
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Country | US
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Telephone | 218-864-5261
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Fax | 218-864-8178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 114231
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License Number State | MN
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