Healthcare Provider Details

I. General information

NPI: 1992700157
Provider Name (Legal Business Name): ROBERT STEPHEN OLSEN PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SELKIRK RD
SANDPOINT ID
83864-7716
US

IV. Provider business mailing address

780 SELKIRK RD
SANDPOINT ID
83864-7716
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-7749
  • Fax: 208-263-4673
Mailing address:
  • Phone: 208-263-7749
  • Fax: 208-263-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH29784
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13242
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: