Provider Demographics
NPI:1336814680
Name:OLIDIA PHARMACY INC
Entity Type:Organization
Organization Name:OLIDIA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWONKAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-567-7780
Mailing Address - Street 1:7530 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3636
Mailing Address - Country:US
Mailing Address - Phone:612-567-7780
Mailing Address - Fax:
Practice Address - Street 1:4105 85TH AVE N STE 101
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2055
Practice Address - Country:US
Practice Address - Phone:763-298-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy