Ethan Michael Odineal, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

2022011896 Issued in MO

Practice address

7909 Highway N
Dardenne Prairie, MO 63368-7382

Phone

(636) 561-8450

Fax

(636) 561-8450

NPI assigned

Nov 22, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hook-Superx LLC

  • Pharmacy
  • Indianapolis, IN
  • NPI 1679514590
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1144824079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7909 HIGHWAY N",
            "city": "DARDENNE PRAIRIE",
            "state": "MO",
            "postal_code": "633687382",
            "telephone_number": "636-561-8450",
            "fax_number": "636-561-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7909 HIGHWAY N",
            "city": "DARDENNE PRAIRIE",
            "state": "MO",
            "postal_code": "633687382",
            "telephone_number": "636-561-8450",
            "fax_number": "636-561-8450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODINEAL",
        "first_name": "ETHAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-22",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "43211",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.304733",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "26029005A",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2022011896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele L Meyer
• Missouri CVS Pharmacy LLC
• Missouri CVS Pharmacy, L.L.C.
• Cynthia J Murphree, FNP BC
• Emily Elizabeth Murphy
• Francis Jay Ohmes, DDS
• Lisa M Panicola
• Dennis Pezzani
• Aaron W Pieper, DMD
• Shirin Pinto, MD

• Pharmacist in Dardenne Prairie, MO
• Providers in Dardenne Prairie, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.