Healthcare Provider Details

I. General information

NPI: 1205990967
Provider Name (Legal Business Name): PATRICIA JO ODWYER RPH, CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W76N677 WAUWATOSA RD
CEDARBURG WI
53012-1707
US

IV. Provider business mailing address

8415 N PORT WASHINGTON RD
FOX POINT WI
53217-2232
US

V. Phone/Fax

Practice location:
  • Phone: 262-377-5060
  • Fax: 262-512-2833
Mailing address:
  • Phone: 414-351-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number9392-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: