Provider Demographics
NPI:1083147805
Name:OLEYNIK, RANDY
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:OLEYNIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13285 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117-9730
Mailing Address - Country:US
Mailing Address - Phone:734-625-5210
Mailing Address - Fax:
Practice Address - Street 1:201 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CARLETON
Practice Address - State:MI
Practice Address - Zip Code:48117-9485
Practice Address - Country:US
Practice Address - Phone:734-654-6252
Practice Address - Fax:734-654-0268
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-08
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020251351835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care