Provider Demographics
NPI:1730145137
Name:ODONNELL, PATRICK KELLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KELLY
Last Name:ODONNELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ESKRIDGE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3554
Mailing Address - Country:US
Mailing Address - Phone:360-753-7421
Mailing Address - Fax:253-473-1158
Practice Address - Street 1:821 S 38TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-5028
Practice Address - Country:US
Practice Address - Phone:253-473-1155
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH0007218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist