Provider Demographics
NPI:1205821329
Name:ODOM, BRANDI LATRICE (PHARMD,FASCP, CFC)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:LATRICE
Last Name:ODOM
Suffix:
Gender:F
Credentials:PHARMD,FASCP, CFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 NW 39TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606
Mailing Address - Country:US
Mailing Address - Phone:352-682-3747
Mailing Address - Fax:251-217-9532
Practice Address - Street 1:1601 SW ARCHER ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-379-4156
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist