Provider Demographics
NPI:1154331205
Name:OLIVER, SALLY J (RPH)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:OLIVER
Suffix:
Gender:F
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:W251 DIVISION ST
Mailing Address - Street 2:PO BOX 365
Mailing Address - City:STEPHENSON
Mailing Address - State:MI
Mailing Address - Zip Code:49887-0365
Mailing Address - Country:US
Mailing Address - Phone:906-753-4898
Mailing Address - Fax:
Practice Address - Street 1:N15019 HANNAHVILLE B-1 ROAD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:MI
Practice Address - Zip Code:49896
Practice Address - Country:US
Practice Address - Phone:906-466-2782
Practice Address - Fax:906-466-7454
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist