Provider Demographics
NPI:1083719322
Name:ODEGARD, PEGGY S (PHARMD, BCPS, CDE)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:S
Last Name:ODEGARD
Suffix:
Gender:F
Credentials:PHARMD, BCPS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CLYDE HILL
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3438
Mailing Address - Country:US
Mailing Address - Phone:415-451-1827
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST # 357630
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-0760
Practice Address - Fax:206-543-3835
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA137841835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy