Provider Demographics
NPI:1124140876
Name:O'DELL, DEBORAH LYNNE (RPH)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LYNNE
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 1:4513 N COUNTRY CT
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-5024
Mailing Address - Country:US
Mailing Address - Phone:797-778-7648
Mailing Address - Fax:
Practice Address - Street 1:1100 URSULINE AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-4951
Practice Address - Country:US
Practice Address - Phone:979-823-1879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist