Provider Demographics
NPI:1184833840
Name:ODOM, JERI ANN (RPH)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:ANN
Last Name:ODOM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:ODOM
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:126 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-2909
Mailing Address - Country:US
Mailing Address - Phone:318-335-5055
Mailing Address - Fax:337-531-3168
Practice Address - Street 1:126 S 9TH ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2909
Practice Address - Country:US
Practice Address - Phone:318-335-5055
Practice Address - Fax:337-531-3168
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist