MEDICARE: DR. MICHELLE RENEE OLSON PHARM.D.

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	PS42411	FL

General Provider Information

NPI Number	:	1427342799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE RENEE OLSON PHARM.D.

Provider Business Mailing Address
First Line	:	2430 SANTA BARBARA BLVD
Second Line	:	T-1454
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4485
Country	:	US
Telephone Number	:	239-458-8570
Fax Number	:	239-458-8570

Provider Business Practice Location Address
First Line	:	2430 SANTA BARBARA BLVD
Second Line	:	T-1454
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-4485
Country	:	US
Telephone Number	:	239-458-8570
Fax Number	:	239-458-8570

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

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	06/04/2011

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