Provider Demographics
NPI:1417187816
Name:ODETT, LYNN M (RPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:ODETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3106
Mailing Address - Country:US
Mailing Address - Phone:315-785-1088
Mailing Address - Fax:315-785-1991
Practice Address - Street 1:1655 STATE STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3106
Practice Address - Country:US
Practice Address - Phone:315-785-1088
Practice Address - Fax:315-785-1991
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist