Provider Demographics
NPI:1669626065
Name:OLSON, KEITH LUVERNE (RPH)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:LUVERNE
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 1:1450 S HIGHWAY 97
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8864
Mailing Address - Country:US
Mailing Address - Phone:541-548-1731
Mailing Address - Fax:541-548-5176
Practice Address - Street 1:1450 S HIGHWAY 97
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-8864
Practice Address - Country:US
Practice Address - Phone:541-548-1731
Practice Address - Fax:541-548-5176
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist