Provider Demographics
NPI:1376924761
Name:OLSON, KARLA M
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 N SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-5074
Mailing Address - Country:US
Mailing Address - Phone:509-744-9891
Mailing Address - Fax:509-742-3494
Practice Address - Street 1:2818 N SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-5074
Practice Address - Country:US
Practice Address - Phone:509-744-9891
Practice Address - Fax:509-742-3494
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00041080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00041080OtherWA LIC NUMBER