Provider Demographics
NPI:1902128283
Name:ODOM, RICHARD DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DOUGLAS
Last Name:ODOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 OAKLINE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-4118
Mailing Address - Country:US
Mailing Address - Phone:205-979-4436
Mailing Address - Fax:
Practice Address - Street 1:545 OAKLINE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-4118
Practice Address - Country:US
Practice Address - Phone:205-979-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist