Healthcare Provider Details

I. General information

NPI: 1508464538
Provider Name (Legal Business Name): HARISH R ODEDRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 TURNBERRY RD
HALF MOON BAY CA
94019-2271
US

IV. Provider business mailing address

2809 OLIVE HWY STE 160
OROVILLE CA
95966-6133
US

V. Phone/Fax

Practice location:
  • Phone: 530-588-1325
  • Fax: 530-660-4551
Mailing address:
  • Phone: 530-588-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number43972
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: