Provider Demographics
NPI:1992262869
Name:OLIVET PHARMACY LLC
Entity type:Organization
Organization Name:OLIVET PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER AND AUTHORIZED SIGN
Authorized Official - Prefix:MR
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-280-5005
Mailing Address - Street 1:116 N. MAIN STREET
Mailing Address - Street 2:SUITE 9403
Mailing Address - City:OLIVET
Mailing Address - State:MI
Mailing Address - Zip Code:49076
Mailing Address - Country:US
Mailing Address - Phone:269-280-5005
Mailing Address - Fax:269-280-5018
Practice Address - Street 1:116 N. MAIN STREET
Practice Address - Street 2:SUITE 9403
Practice Address - City:OLIVET
Practice Address - State:MI
Practice Address - Zip Code:49076
Practice Address - Country:US
Practice Address - Phone:269-280-5005
Practice Address - Fax:269-280-5018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy