Provider Demographics
NPI:1801113980
Name:OLSOVSKY, ALBERT EUGENE
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:EUGENE
Last Name:OLSOVSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 S VALLEY MILLS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1602
Mailing Address - Country:US
Mailing Address - Phone:254-757-3344
Mailing Address - Fax:254-754-7119
Practice Address - Street 1:1110 S VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1602
Practice Address - Country:US
Practice Address - Phone:254-757-3344
Practice Address - Fax:254-754-7119
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist