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General NPI Number Information
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NPI Number | 1952345159
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Entity Type | Organization
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Legal Business Name | ODON PHARMACY LLC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 200 W MAIN ST
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City | ODON
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State | IN
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Zip | 47562-1218
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Country | US
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Telephone | 812-636-4600
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Fax | 812-636-8004
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Provider Business Mailing Address
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Address Line | PO BOX 355
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City | ODON
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State | IN
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Zip | 47562-0355
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Country | US
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Telephone | 812-636-4600
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Fax | 812-636-8004
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Authorized Official
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Title or Position | OWNER,PIC,AO
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Name | KENNETH HOLLAND
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Credential | RPH
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Telephone | 812-636-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60003675A
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License Number State | IN
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