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NPI Code Detail

MEDICARE: DIANA K. ODUM RPH

MEDICARE: DIANA K. ODUM RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist0000011892TN

General Provider Information

NPI Number : 1003191354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA K. ODUM RPH
Provider Business Mailing Address
First Line : 324 OKMULGEE CIR
Second Line :
City : LOUDON
State : TN
Zip : 37774-2144
Country : US
Telephone Number : 865-458-4439
Fax Number :
Provider Business Practice Location Address
First Line : 8950 KINGSTON PIKE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-5003
Country : US
Telephone Number : 865-694-1186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 10/19/2011

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