Provider Demographics
NPI:1144260381
Name:OLSON, MARK ALBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALBERT
Last Name:OLSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W MARKETVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1221
Mailing Address - Country:US
Mailing Address - Phone:217-352-1987
Mailing Address - Fax:217-352-2356
Practice Address - Street 1:915 W MARKETVIEW DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1221
Practice Address - Country:US
Practice Address - Phone:217-352-1987
Practice Address - Fax:217-352-2356
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist