MEDICARE: MR. DOUGLAS E OLSON CPH

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	PH 19231	FL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PU 3902	FL

General Provider Information

NPI Number	:	1154635258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS E OLSON CPH

Provider Business Mailing Address
First Line	:	75 S TUTTLE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34237-6329
Country	:	US
Telephone Number	:	941-915-0298
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 S TUTTLE AVE
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34237-6329
Country	:	US
Telephone Number	:	941-915-0298
Fax Number	:

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

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/30/2010

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