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General NPI Number Information
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NPI Number | 1639205305
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Entity Type | Individual
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Provider Name | ROBERT KENT OLSON R.PH.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9077 N. DEERBROOK TRAIL
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City | BROWN DEER
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State | WI
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Zip | 53223
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Country | US
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Telephone | 414-586-0845
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Fax | 414-586-0852
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Provider Business Mailing Address
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Address Line | N66W13791 CRESTWOOD DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-6063
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Country | US
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Telephone | 262-703-0705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12148-040
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License Number State | WI
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