Provider Demographics
NPI:1649471616
Name:OLSON, STEVEN PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PAUL
Last Name:OLSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:PAUL
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 FAIRVIEW BLVD
Mailing Address - Street 2:PO BOX 95
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2848
Mailing Address - Country:US
Mailing Address - Phone:651-267-5260
Mailing Address - Fax:651-267-5936
Practice Address - Street 1:701 FAIRVIEW BLVD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2848
Practice Address - Country:US
Practice Address - Phone:651-267-5260
Practice Address - Fax:651-267-5936
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist