Provider Demographics
NPI:1215429634
Name:OLSZEWSKI, GARY PAUL (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:PAUL
Last Name:OLSZEWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 S 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-3610
Mailing Address - Country:US
Mailing Address - Phone:262-780-1910
Mailing Address - Fax:262-780-1914
Practice Address - Street 1:2720 S 163RD ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3610
Practice Address - Country:US
Practice Address - Phone:262-780-1910
Practice Address - Fax:262-780-1914
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11355-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist