Provider Demographics
NPI:1871860957
Name:OLSON, KEVIN CRAIG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CRAIG
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 1:3501 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3406
Mailing Address - Country:US
Mailing Address - Phone:515-271-5074
Mailing Address - Fax:515-271-5058
Practice Address - Street 1:3501 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3406
Practice Address - Country:US
Practice Address - Phone:515-271-5074
Practice Address - Fax:515-271-5058
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist