Provider Demographics
NPI:1891803284
Name:ODONNELL, MARY T (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1035 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1226
Mailing Address - Country:US
Mailing Address - Phone:317-873-2008
Mailing Address - Fax:317-216-2919
Practice Address - Street 1:4880 CENTURY PLAZA RD
Practice Address - Street 2:SUITE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5469
Practice Address - Country:US
Practice Address - Phone:317-216-2900
Practice Address - Fax:317-216-2919
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012977A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist