Healthcare Provider Details

I. General information

NPI: 1891156493
Provider Name (Legal Business Name): CARLA O'DONNELL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ANNIE GEORGE DR
MASHANTUCKET CT
06338-3801
US

IV. Provider business mailing address

43 SPENCER CT
WAKEFIELD RI
02879-2820
US

V. Phone/Fax

Practice location:
  • Phone: 860-396-6430
  • Fax:
Mailing address:
  • Phone: 401-527-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH03401
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH20274
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT0011256
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: