Provider Demographics
NPI:1407144074
Name:OLSON, KEVIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
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 1:15800 87TH ST NE
Mailing Address - Street 2:T2456
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6546
Mailing Address - Country:US
Mailing Address - Phone:763-252-1316
Mailing Address - Fax:763-252-1326
Practice Address - Street 1:15800 87TH ST NE
Practice Address - Street 2:T2456
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6546
Practice Address - Country:US
Practice Address - Phone:763-252-1316
Practice Address - Fax:763-252-1326
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist