Healthcare Provider Details

I. General information

NPI: 1205821329
Provider Name (Legal Business Name): BRANDI LATRICE ODOM PHARM.D.,FASCP, CFC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER ROAD
GAINESVILLE FL
32608
US

IV. Provider business mailing address

5400 NW 39TH AVENUE
GAINESVILLE FL
32606
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-379-4156
Mailing address:
  • Phone: 352-682-3747
  • Fax: 251-217-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2323
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: