Healthcare Provider Details

I. General information

NPI: 1992819239
Provider Name (Legal Business Name): ROBERT BROOKS ODOM PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

691 STERLING DR
CHARLESTON SC
29412-9135
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7339
  • Fax:
Mailing address:
  • Phone: 843-762-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5497
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: