Provider Demographics
NPI:1689797094
Name:OLSEN, JUDITH B (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:B
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 MIDDLETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06472
Mailing Address - Country:US
Mailing Address - Phone:203-484-0431
Mailing Address - Fax:203-484-2693
Practice Address - Street 1:1395 MIDDLETOWN AVE.
Practice Address - Street 2:
Practice Address - City:NORTHFORD
Practice Address - State:CT
Practice Address - Zip Code:06472
Practice Address - Country:US
Practice Address - Phone:203-484-0431
Practice Address - Fax:203-484-2693
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist