Provider Demographics
NPI:1013147560
Name:O'DELL, LORI ANN (RPH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:O'DELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 JORDEN LN SPACE #6
Mailing Address - Street 2:
Mailing Address - City:FILER
Mailing Address - State:ID
Mailing Address - Zip Code:83328
Mailing Address - Country:US
Mailing Address - Phone:208-850-2666
Mailing Address - Fax:
Practice Address - Street 1:306 BLUE LAKES BLVD N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-734-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-18
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist