Provider Demographics
NPI:1861862252
Name:OLESEN, BRANDON H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:H
Last Name:OLESEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 US HIGHWAY 93 N
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-9053
Mailing Address - Country:US
Mailing Address - Phone:406-297-7748
Mailing Address - Fax:406-297-7492
Practice Address - Street 1:546 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9053
Practice Address - Country:US
Practice Address - Phone:406-297-7748
Practice Address - Fax:406-297-7492
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-32258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist