Healthcare Provider Details

I. General information

NPI: 1073518528
Provider Name (Legal Business Name): JOSEPH HAMILTON ODOM R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 MAIN ST
CONWAY SC
29526-3572
US

IV. Provider business mailing address

1608 MAIN ST
CONWAY SC
29526-3572
US

V. Phone/Fax

Practice location:
  • Phone: 843-248-4700
  • Fax: 843-488-6346
Mailing address:
  • Phone: 843-687-2100
  • Fax: 843-493-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4988
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: