Provider Demographics
NPI:1922386721
Name:OLSON, JENNY LYN (RPH)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:LYN
Last Name:OLSON
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 1:1057 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2270
Mailing Address - Country:US
Mailing Address - Phone:231-398-3202
Mailing Address - Fax:231-398-3246
Practice Address - Street 1:1057 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2270
Practice Address - Country:US
Practice Address - Phone:231-398-3202
Practice Address - Fax:231-398-3246
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025658183500000X
FLPS21244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS21244OtherPHARMACIST LICENSE
MI5302025658OtherPHARMACIST LICENSE