MEDICARE: ODEDRA ENTERPRISES, INC.

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
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
2	282E00000X	Long Term Care Hospital
3	3336C0003X	Community/Retail Pharmacy	PHY53577	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2157440	OTHER		PK

General Provider Information

NPI Number	:	1174677827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODEDRA ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	2809 OLIVE HWY
Second Line	:	SUITE 160
City	:	OROVILLE
State	:	CA
Zip	:	95966-6131
Country	:	US
Telephone Number	:	530-533-1545
Fax Number	:	530-533-5963

Provider Business Practice Location Address
First Line	:	2809 OLIVE HWY
Second Line	:	SUITE 160
City	:	OROVILLE
State	:	CA
Zip	:	95966-6131
Country	:	US
Telephone Number	:	530-533-1545
Fax Number	:	530-533-5963

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BETTY L RIDDLE
Credential	:
Telephone Number	:	530-588-1325

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/17/2025

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Directions to “ODEDRA ENTERPRISES, INC. ” Practice Location

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