Provider Demographics
NPI:1215911649
Name:OLSEN, NATALIE LOUISE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:LOUISE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24020 HEWETT RD
Mailing Address - Street 2:
Mailing Address - City:JULIAETTA
Mailing Address - State:ID
Mailing Address - Zip Code:83535-6137
Mailing Address - Country:US
Mailing Address - Phone:208-244-1142
Mailing Address - Fax:
Practice Address - Street 1:415 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2431
Practice Address - Country:US
Practice Address - Phone:208-750-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist