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Export Provider Record NPI 1124060652
Olivet Pharmacy Inc
Organization Subpart: NO
Active
NPI Number1124060652
NPI TypeNPI-2 Organization
SpecialtyPharmacy, Community/Retail Pharmacy
Provider Details
NPI1124060652
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2006-06-11
Last Updated2011-09-27
Authorized OfficialGlenda King
PRESIDENT AND OWNER
Phone: 2697492301
Mailing AddressPo Box 537
Olivet, MI 49076-0537
United States
📍 View Map
Primary Practice Address102 Washington St
Olivet, MI 49076-9462
United States
Phone: (269) 749-2301 | Fax: (269) 749-2301
📍 View Map
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMI1737040
Other (non-Medicare)2318978NCPDP Provider Identification Number
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
No333600000X – Pharmacy
Yes3336C0003X – Pharmacy, Community/Retail PharmacyMI5301000875
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About NPI 1124060652

Olivet Pharmacy Inc is an organization registered in the CMS NPPES NPI Registry with NPI number 1124060652. The primary specialty listed is Pharmacy, Community/Retail Pharmacy. The organization is located in Olivet, MI. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2006-06-11. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1124060652?

NPI 1124060652 belongs to Olivet Pharmacy Inc, a Pharmacy, Community/Retail Pharmacy in Olivet, MI. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1124060652 active?

The current status of NPI 1124060652 in the NPPES registry is Active. The record was last updated on 2011-09-27.

What specialty is NPI 1124060652?

NPI 1124060652 is classified under the taxonomy Pharmacy, Community/Retail Pharmacy. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1124060652?

You can verify NPI 1124060652 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1124060652?

The primary practice address on file for NPI 1124060652 is 102 Washington St, Olivet, MI 49076-9462. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1124060652 issued?

NPI 1124060652 was first issued (enumerated) on 2006-06-11. The NPPES record was last updated on 2011-09-27.

Practice Location Map

Olivet Pharmacy Inc is located at 102 Washington St, Olivet, MI. Use the map below to find directions or verify the practice location.

📍 102 Washington St, Olivet, MI 49076-9462  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Olivet Pharmacy Inc. All records sourced from the CMS NPPES registry.

License Information

The following state license numbers are on file in the NPPES registry for NPI 1124060652. For license status verification, contact the relevant state licensing board directly.

Specialty / TaxonomyLicense NumberState
Pharmacy, Community/Retail Pharmacy5301000875MI
Data Verified from CMS NPPES Last synced: 2026-06-29 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162