Provider Demographics
NPI:1730307869
Name:ODLAND, MARK STEVEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEVEN
Last Name:ODLAND
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E WASHINGTON
Mailing Address - Street 2:BOX 322
Mailing Address - City:DOWS
Mailing Address - State:IA
Mailing Address - Zip Code:50071
Mailing Address - Country:US
Mailing Address - Phone:515-852-3585
Mailing Address - Fax:
Practice Address - Street 1:107 E ELLSWORTH
Practice Address - Street 2:BOX 367
Practice Address - City:DOWS
Practice Address - State:IA
Practice Address - Zip Code:50071
Practice Address - Country:US
Practice Address - Phone:515-852-3833
Practice Address - Fax:515-852-3833
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist