MEDICARE: ALICIA OLSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	54834	TX

General Provider Information

NPI Number	:	1063079374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA OLSON PHARMD

Provider Business Mailing Address
First Line	:	1702 SANTA FE DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-6420
Country	:	US
Telephone Number	:	817-594-3435
Fax Number	:	817-594-7772

Provider Business Practice Location Address
First Line	:	1702 SANTA FE DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-6420
Country	:	US
Telephone Number	:	817-594-3435
Fax Number	:	817-594-7772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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Directions to “ ALICIA OLSON PHARMD” Practice Location

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