MEDICARE: KRISTY OLSON PHARMACY TECH A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	VA00020831	WA

General Provider Information

NPI Number	:	1891779104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY OLSON PHARMACY TECH A

Provider Business Mailing Address
First Line	:	621 SR 9 NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258
Country	:	US
Telephone Number	:	425-334-4028
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 SR 9
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8525
Country	:	US
Telephone Number	:	425-334-4028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	01/27/2009

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