Provider Demographics
NPI:1093722589
Name:OLSON, CARL M (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20770 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9119
Mailing Address - Country:US
Mailing Address - Phone:734-475-2712
Mailing Address - Fax:
Practice Address - Street 1:7039 DEXTER ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-8568
Practice Address - Country:US
Practice Address - Phone:734-426-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302030040OtherREGISTERED PHARMACIST