Provider Demographics
NPI:1902646938
Name:OLSTAD, STACEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:OLSTAD
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 1:1975 SE CRYSTAL LAKE DR UNIT 112
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-0005
Mailing Address - Country:US
Mailing Address - Phone:541-231-0241
Mailing Address - Fax:
Practice Address - Street 1:203 PHARMACY BLDG BLDG 1601SW
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8537
Practice Address - Country:US
Practice Address - Phone:541-737-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011402333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy