Provider Demographics
NPI:1679705149
Name:OLSON, LANCE E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:E
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 1:1730 NE PECAN LN
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-1274
Mailing Address - Country:US
Mailing Address - Phone:952-913-7886
Mailing Address - Fax:
Practice Address - Street 1:1730 NE PECAN LN
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-1274
Practice Address - Country:US
Practice Address - Phone:952-913-7886
Practice Address - Fax:952-496-3138
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117430183500000X
ORRPH-0015158183500000X
WAPH60551188183500000X
AZS011923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist