Provider Demographics
NPI:1194063776
Name:OLSEN, KATE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
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 1:609 SPEYERS RD
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1050
Mailing Address - Country:US
Mailing Address - Phone:509-698-1345
Mailing Address - Fax:509-697-2217
Practice Address - Street 1:609 SPEYERS RD
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1050
Practice Address - Country:US
Practice Address - Phone:509-698-1345
Practice Address - Fax:509-697-2217
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH602162661835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60216266OtherPHARMACIST LICENSE