Provider Demographics
NPI:1063749059
Name:OLSEN, KRISTIAN L (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:L
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1867
Mailing Address - Country:US
Mailing Address - Phone:913-268-8150
Mailing Address - Fax:
Practice Address - Street 1:12010 W 63RD ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1867
Practice Address - Country:US
Practice Address - Phone:913-268-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist