Provider Demographics
NPI:1679175533
Name:O'DELL, RICHARD SEAN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SEAN
Last Name:O'DELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45101 FIRST COLONY WAY
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2416
Mailing Address - Country:US
Mailing Address - Phone:240-725-5199
Mailing Address - Fax:
Practice Address - Street 1:45101 FIRST COLONY WAY
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2416
Practice Address - Country:US
Practice Address - Phone:240-725-5199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist