Provider Demographics
NPI:1588251607
Name:OLSON, RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1240
Mailing Address - Country:US
Mailing Address - Phone:860-966-4099
Mailing Address - Fax:
Practice Address - Street 1:23 KILLINGWORTH RD
Practice Address - Street 2:
Practice Address - City:HIGGANUM
Practice Address - State:CT
Practice Address - Zip Code:06441-4242
Practice Address - Country:US
Practice Address - Phone:860-345-3607
Practice Address - Fax:860-345-3611
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist