Healthcare Provider Details

I. General information

NPI: 1609652726
Provider Name (Legal Business Name): KRISTA LORYLL OLSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 FULTON ST SE
MINNEAPOLIS MN
55455-4800
US

IV. Provider business mailing address

711 KASOTA AVE SE
MINNEAPOLIS MN
55414-2842
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-9709
  • Fax:
Mailing address:
  • Phone: 612-624-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number126614
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22377
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: