Provider Demographics
NPI:1821422874
Name:OLSON, MARIAH J (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:J
Last Name:OLSON
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 1:11990 BUSINESS PARK BLVD N
Mailing Address - Street 2:T-1831
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2005
Mailing Address - Country:US
Mailing Address - Phone:763-354-1007
Mailing Address - Fax:
Practice Address - Street 1:11990 BUSINESS PARK BLVD N
Practice Address - Street 2:T-1831
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2005
Practice Address - Country:US
Practice Address - Phone:763-354-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist