Provider Demographics
NPI:1275792384
Name:ODISH, ROD HANI (RPH)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:HANI
Last Name:ODISH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:RAID
Other - Middle Name:HANI
Other - Last Name:ODISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3050 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4509
Mailing Address - Country:US
Mailing Address - Phone:248-363-4392
Mailing Address - Fax:248-363-7223
Practice Address - Street 1:3050 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4509
Practice Address - Country:US
Practice Address - Phone:248-363-4392
Practice Address - Fax:248-363-7223
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist