Provider Demographics
NPI:1043504574
Name:OLLERMAN INC
Entity type:Organization
Organization Name:OLLERMAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-227-8265
Mailing Address - Street 1:1571 W VILLARD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4656
Mailing Address - Country:US
Mailing Address - Phone:701-227-8265
Mailing Address - Fax:701-227-8289
Practice Address - Street 1:1571 W VILLARD ST STE 1
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4656
Practice Address - Country:US
Practice Address - Phone:701-227-8265
Practice Address - Fax:701-227-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NDPHAR3273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455403Medicaid
2131219OtherPK
ND21569Medicaid