Provider Demographics
NPI:1306147954
Name:OLSEN, LISA LYNETTE (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNETTE
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1062
Mailing Address - Country:US
Mailing Address - Phone:406-846-1414
Mailing Address - Fax:406-846-2884
Practice Address - Street 1:201 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1062
Practice Address - Country:US
Practice Address - Phone:406-846-1414
Practice Address - Fax:406-846-2884
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist