Provider Demographics
NPI:1649791724
Name:ODOM, MARINA GALE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:GALE
Last Name:ODOM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PROSPERITY LN
Mailing Address - Street 2:
Mailing Address - City:PINEBLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28373-4401
Mailing Address - Country:US
Mailing Address - Phone:443-859-5483
Mailing Address - Fax:
Practice Address - Street 1:720 E HWY 74 BUS
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379
Practice Address - Country:US
Practice Address - Phone:910-582-3565
Practice Address - Fax:910-582-3574
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist