Provider Demographics
NPI:1003140591
Name:O'DELL, BETTY (RPH)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:
Last Name:O'DELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 N CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1747
Mailing Address - Country:US
Mailing Address - Phone:419-222-0778
Mailing Address - Fax:419-224-4692
Practice Address - Street 1:927 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1747
Practice Address - Country:US
Practice Address - Phone:419-222-0778
Practice Address - Fax:419-224-4692
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03110965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist