Provider Demographics
NPI:1205990967
Name:ODWYER, PATRICIA JO (RPH, CGP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JO
Last Name:ODWYER
Suffix:
Gender:F
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2232
Mailing Address - Country:US
Mailing Address - Phone:414-351-6892
Mailing Address - Fax:
Practice Address - Street 1:W76N677 WAUWATOSA RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1707
Practice Address - Country:US
Practice Address - Phone:262-377-5060
Practice Address - Fax:262-512-2833
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9392-0401835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric