Healthcare Provider Details

I. General information

NPI: 1104952282
Provider Name (Legal Business Name): DEBORAH JEAN ODENS P.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GALL ST.
LOWER BRULE SD
57548
US

IV. Provider business mailing address

712 N MAIN ST
CHAMBERLAIN SD
57325-1271
US

V. Phone/Fax

Practice location:
  • Phone: 605-473-8227
  • Fax: 605-473-0708
Mailing address:
  • Phone: 605-234-5833
  • Fax: 605-473-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR4362
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: