Healthcare Provider Details

I. General information

NPI: 1033021423
Provider Name (Legal Business Name): SHANNON OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 WALNUT CREEK LN
ANN ARBOR MI
48105-9477
US

IV. Provider business mailing address

5221 WALNUT CREEK LN
ANN ARBOR MI
48105-9477
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-2478
  • Fax:
Mailing address:
  • Phone: 734-655-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302027123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: