Provider Demographics
NPI:1851699011
Name:OLSON, STACY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6611
Mailing Address - Country:US
Mailing Address - Phone:360-344-3444
Mailing Address - Fax:360-344-3444
Practice Address - Street 1:442 W SIMS WAY
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-1811
Practice Address - Country:US
Practice Address - Phone:360-385-2860
Practice Address - Fax:360-344-3444
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60141602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist