Provider Demographics
NPI:1902199235
Name:OLSON, KEVIN EVAN (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:EVAN
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 1:819 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-3426
Mailing Address - Country:US
Mailing Address - Phone:801-465-0363
Mailing Address - Fax:801-465-0379
Practice Address - Street 1:819 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-3426
Practice Address - Country:US
Practice Address - Phone:801-465-0363
Practice Address - Fax:801-465-0379
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT354429-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist