Provider Demographics
NPI:1003191354
Name:ODUM, DIANA K (RPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:ODUM
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 1:324 OKMULGEE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-2144
Mailing Address - Country:US
Mailing Address - Phone:865-458-4439
Mailing Address - Fax:
Practice Address - Street 1:8950 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5003
Practice Address - Country:US
Practice Address - Phone:865-694-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist