Provider Demographics
NPI:1811243702
Name:OLSON, MAURICE (RPH,MFT)
Entity type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:RPH,MFT
Other - Prefix:MR
Other - First Name:MORRIE
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH,MFT
Mailing Address - Street 1:4649 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1752
Mailing Address - Country:US
Mailing Address - Phone:267-994-9631
Mailing Address - Fax:
Practice Address - Street 1:4649 CANTERBURY CT
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1752
Practice Address - Country:US
Practice Address - Phone:215-757-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029306L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy