Provider Demographics
NPI:1902635303
Name:OLSSON, MELISSA JO
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:OLSSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WARNER RD NE APT 3
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-3339
Mailing Address - Country:US
Mailing Address - Phone:218-831-0886
Mailing Address - Fax:
Practice Address - Street 1:2750 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-9741
Practice Address - Country:US
Practice Address - Phone:406-443-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT102686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist