Provider Demographics
NPI:1386853869
Name:BULL, PHYLLIS ODDOYE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:ODDOYE
Last Name:BULL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14470 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:COOKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21723-9512
Mailing Address - Country:US
Mailing Address - Phone:410-489-0931
Mailing Address - Fax:410-489-0932
Practice Address - Street 1:5401 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5103
Practice Address - Country:US
Practice Address - Phone:410-521-8823
Practice Address - Fax:410-521-8889
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist