Provider Demographics
NPI:1215223797
Name:OLSEN, KOLTON CLAIR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KOLTON
Middle Name:CLAIR
Last Name:OLSEN
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 1:1401 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2187
Mailing Address - Country:US
Mailing Address - Phone:206-494-3251
Mailing Address - Fax:206-494-3256
Practice Address - Street 1:1401 2ND AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2187
Practice Address - Country:US
Practice Address - Phone:206-494-3251
Practice Address - Fax:206-494-3256
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2015-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6000384-1701183500000X
UT6000384-8911183500000X
ORRPH-0014245183500000X
WAPH60485475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist