Provider Demographics
NPI:1982828109
Name:OLSON, KRISTOPHER L (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:L
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 1:1989 OLD HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-8240
Mailing Address - Country:US
Mailing Address - Phone:509-422-9903
Mailing Address - Fax:
Practice Address - Street 1:1003 KOALA AVE
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9247
Practice Address - Country:US
Practice Address - Phone:509-422-9903
Practice Address - Fax:509-422-7689
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist