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General NPI Number Information
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NPI Number | 1386247245
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Entity Type | Individual
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Provider Name | ODOM LIM PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 240 INDEPENDENCE WAY
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City | DANVERS
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State | MA
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Zip | 01923-3653
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Country | US
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Telephone | 978-762-4439
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Fax |
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Provider Business Mailing Address
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Address Line | 59 WASHINGTON ST APT 1
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City | LOWELL
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State | MA
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Zip | 01851-3344
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Country | US
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Telephone | 978-458-3159
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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 | PH239550
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License Number State | MA
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