Provider Demographics
NPI:1407228455
Name:ODA, KATHY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ODA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OAKDALE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 OAKDALE RD
Practice Address - Street 2:SUITE F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4592
Practice Address - Country:US
Practice Address - Phone:209-525-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 37879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist