Provider Demographics
NPI:1902526965
Name:OLSEN, HOWARD LYLE (RPH)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:LYLE
Last Name:OLSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8749 STONE HARBOUR LOOP
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-6324
Mailing Address - Country:US
Mailing Address - Phone:941-962-8741
Mailing Address - Fax:
Practice Address - Street 1:2134 GULF GATE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4813
Practice Address - Country:US
Practice Address - Phone:941-493-6500
Practice Address - Fax:941-493-6552
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist