MEDICARE: JAMIE HEATHER OLSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1568147312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE HEATHER OLSEN

Provider Business Mailing Address
First Line	:	2280 W ALEXANDER ST
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-2051
Country	:	US
Telephone Number	:	801-266-3999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 W ALEXANDER ST
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-2051
Country	:	US
Telephone Number	:	801-266-3999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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