1730307869 NPI number — MR. MARK STEVEN ODLAND PHARMACIST

Table of content: MR. MARK STEVEN ODLAND PHARMACIST (NPI 1730307869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730307869 NPI number — MR. MARK STEVEN ODLAND PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODLAND
Provider First Name:
MARK
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730307869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 E WASHINGTON
Provider Second Line Business Mailing Address:
BOX 322
Provider Business Mailing Address City Name:
DOWS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-852-3585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 E ELLSWORTH
Provider Second Line Business Practice Location Address:
BOX 367
Provider Business Practice Location Address City Name:
DOWS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-852-3833
Provider Business Practice Location Address Fax Number:
515-852-3833
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  16408 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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