Provider Demographics
NPI:1669151726
Name:OLSEN, NICHOLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:OLSEN
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 1:9504 MINORCA WAY APT 305
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-8199
Mailing Address - Country:US
Mailing Address - Phone:917-513-6630
Mailing Address - Fax:
Practice Address - Street 1:6545 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6330
Practice Address - Country:US
Practice Address - Phone:772-233-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist