Provider Demographics
NPI:1902335607
Name:ODOM, CALVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:
Last Name:ODOM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-4402
Mailing Address - Country:US
Mailing Address - Phone:336-237-0648
Mailing Address - Fax:336-237-0684
Practice Address - Street 1:800 E CENTER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-4402
Practice Address - Country:US
Practice Address - Phone:336-237-0648
Practice Address - Fax:336-237-0684
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist