Provider Demographics
NPI:1790810158
Name:OLIN, JACQUELINE L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:L
Last Name:OLIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:L
Other - Last Name:FEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:113 NORTH AMES STREET
Mailing Address - Street 2:MATTHEWS HEALTH CLINIC
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:704-841-8882
Mailing Address - Fax:
Practice Address - Street 1:3027 BROOK VALLEY RUN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-6336
Practice Address - Country:US
Practice Address - Phone:704-218-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0070 01961835P0018X
NC192961835P1200X
NJRI253071835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist