Provider Demographics
NPI:1356510275
Name:OLSON, GILBERT BRUCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:BRUCE
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 1:3534 SKYCROFT DR
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1780
Mailing Address - Country:US
Mailing Address - Phone:612-788-0507
Mailing Address - Fax:763-236-9381
Practice Address - Street 1:3534 SKYCROFT DR
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-1780
Practice Address - Country:US
Practice Address - Phone:612-788-0507
Practice Address - Fax:763-236-9381
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist