Provider Demographics
NPI:1356864326
Name:RUNDBERG, OLGA JENNIFER (PHARMD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:JENNIFER
Last Name:RUNDBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 W 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4786
Mailing Address - Country:US
Mailing Address - Phone:303-427-9295
Mailing Address - Fax:303-430-6603
Practice Address - Street 1:1575 W 84TH AVE
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-4786
Practice Address - Country:US
Practice Address - Phone:303-427-9295
Practice Address - Fax:303-430-6603
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0021792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist