Provider Demographics
NPI:1710670666
Name:OLSON, JOSEPH J (CPHT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:OLSON
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20411 JUNE GRASS DR
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-5201
Mailing Address - Country:US
Mailing Address - Phone:763-670-5204
Mailing Address - Fax:
Practice Address - Street 1:18267 CARSON CT NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2733
Practice Address - Country:US
Practice Address - Phone:763-670-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN735774183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician