Healthcare Provider Details

I. General information

NPI: 1528482585
Provider Name (Legal Business Name): ANDREW ODEAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WABASHA ST S
SAINT PAUL MN
55107-1819
US

IV. Provider business mailing address

130 WABASHA ST S
SAINT PAUL MN
55107-1819
US

V. Phone/Fax

Practice location:
  • Phone: 651-829-2240
  • Fax: 651-829-2250
Mailing address:
  • Phone: 651-829-2240
  • Fax: 651-829-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number121487
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: