Provider Demographics
NPI:1619402039
Name:OLYMPUS LABORATORIES, LLC
Entity Type:Organization
Organization Name:OLYMPUS LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-448-4422
Mailing Address - Street 1:32 W WINCHESTER ST
Mailing Address - Street 2:100
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5607
Mailing Address - Country:US
Mailing Address - Phone:801-448-4422
Mailing Address - Fax:
Practice Address - Street 1:421 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-1434
Practice Address - Country:US
Practice Address - Phone:801-448-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory