Active NPI
Jenny Lyn Olson, RPH
- Pharmacist
- Manistee, MI
National Provider Identifier
1922386721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302025658
- Practice address
- 1057 US Highway 31 S
Manistee, MI 49660-2270 - Phone
- (231) 398-3202
- Fax
- (231) 398-3246
- NPI assigned
- Jul 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302025658 | MI | Primary |
| Pharmacist | 183500000X | PS21244 | FL |
Addresses
Primary practice location
1057 US Highway 31 S
Manistee, MI 49660-2270
Mailing address
1057 US Highway 31 S
Manistee, MI 49660-2270
Phone (231) 398-3202
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS21244 | Other | FL | PHARMACIST LICENSE |
| 5302025658 | Other | MI | PHARMACIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS21244 | FL | MD | Pharmacist |
| 5302025658 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prevos Family Markets LLC | Past | Accepting new patients | |
| Prevos Family Markets LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Manistee, MI
- NPI 1245465111
-
- Community/Retail Pharmacy
- Battle Creek, MI
- NPI 1881832830
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311724800000",
"number": "1922386721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1057 US HIGHWAY 31 S",
"city": "MANISTEE",
"state": "MI",
"postal_code": "496602270",
"telephone_number": "231-398-3202",
"fax_number": "231-398-3246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1057 US HIGHWAY 31 S",
"city": "MANISTEE",
"state": "MI",
"postal_code": "496602270",
"telephone_number": "231-398-3202",
"fax_number": "231-398-3246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "JENNY",
"middle_name": "LYN",
"name_prefix": "Ms.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-27",
"last_updated": "2011-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302025658",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS21244",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "PS21244",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "5302025658",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manistee, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.