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General NPI Number Information
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NPI Number | 1366673287
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Entity Type | Individual
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Provider Name | LAVAN KUMAR ODAPALLY RPH
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Gender | Male
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 302 W MAIN ST
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City | HARTFORD
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State | MI
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Zip | 49057-1008
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Country | US
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Telephone | 269-621-3654
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Fax | 269-621-3534
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Provider Business Mailing Address
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Address Line | 3130 STONEBRIDGE CT 11
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City | PORTAGE
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State | MI
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Zip | 49024-8048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302036805
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License Number State | MI
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