Provider Demographics
NPI:1316619315
Name:OLWINE, JANA
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:OLWINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4365 E PALO VERDE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1579
Mailing Address - Country:US
Mailing Address - Phone:513-461-4607
Mailing Address - Fax:
Practice Address - Street 1:975 E OCOTILLO RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3013
Practice Address - Country:US
Practice Address - Phone:480-214-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist