Provider Demographics
NPI:1740304146
Name:ODETTE, SHEILA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:ODETTE
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 1:15774 CANDLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-6011
Mailing Address - Country:US
Mailing Address - Phone:810-730-3915
Mailing Address - Fax:
Practice Address - Street 1:1425 S MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916
Practice Address - Country:US
Practice Address - Phone:810-730-3915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033022183500000X
CO17124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist