Provider Demographics
NPI:1740874692
Name:OLSEN, LINA GRISELL (SENIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:GRISELL
Last Name:OLSEN
Suffix:
Gender:F
Credentials:SENIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W ALLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1718
Mailing Address - Country:US
Mailing Address - Phone:201-327-4901
Mailing Address - Fax:201-327-2639
Practice Address - Street 1:44 W ALLENDALE AVE
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1718
Practice Address - Country:US
Practice Address - Phone:201-327-4901
Practice Address - Fax:201-327-2639
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW03648500183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician