Provider Demographics
NPI:1639205305
Name:OLSON, ROBERT KENT (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KENT
Last Name:OLSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N66W13791 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6063
Mailing Address - Country:US
Mailing Address - Phone:262-703-0705
Mailing Address - Fax:
Practice Address - Street 1:9077 N. DEERBROOK TRAIL
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:414-586-0845
Practice Address - Fax:414-586-0852
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12148-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist