Provider Demographics
NPI:1497391445
Name:OLSON, LEA MAE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:MAE
Last Name:OLSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23101 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-1475
Mailing Address - Country:US
Mailing Address - Phone:248-658-1660
Mailing Address - Fax:248-658-1665
Practice Address - Street 1:23101 JOHN R RD
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030-1475
Practice Address - Country:US
Practice Address - Phone:248-658-1660
Practice Address - Fax:248-658-1665
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist