Provider Demographics
NPI:1427342799
Name:OLSON, MICHELLE RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENEE
Last Name:OLSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 SANTA BARBARA BLVD
Mailing Address - Street 2:T-1454
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4485
Mailing Address - Country:US
Mailing Address - Phone:239-458-8570
Mailing Address - Fax:239-458-8570
Practice Address - Street 1:2430 SANTA BARBARA BLVD
Practice Address - Street 2:T-1454
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4485
Practice Address - Country:US
Practice Address - Phone:239-458-8570
Practice Address - Fax:239-458-8570
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist