Provider Demographics
NPI:1972107993
Name:ODONNELL, GERALD III (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:ODONNELL
Suffix:III
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 1:2548 E ANN ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4949
Mailing Address - Country:US
Mailing Address - Phone:267-319-5457
Mailing Address - Fax:
Practice Address - Street 1:8525 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2444
Practice Address - Country:US
Practice Address - Phone:215-331-9762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist