MEDICARE: MARY T ODONNELL 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
1	183500000X	Pharmacist	26012977A	IN

General Provider Information

NPI Number	:	1891803284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY T ODONNELL RPH

Provider Business Mailing Address
First Line	:	1035 W POPLAR ST
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1226
Country	:	US
Telephone Number	:	317-873-2008
Fax Number	:	317-216-2919

Provider Business Practice Location Address
First Line	:	4880 CENTURY PLAZA RD
Second Line	:	SUITE 150
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5469
Country	:	US
Telephone Number	:	317-216-2900
Fax Number	:	317-216-2919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	07/08/2007

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