Active NPI
David Carroll Odom, RPH
- Pharmacist
- Poplar Bluff, MO
National Provider Identifier
1417122565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 42049
- Practice address
- 5841 Quail Meadows Dr
Poplar Bluff, MO 63901-8542 - Phone
- (573) 686-7238
- NPI assigned
- Apr 29, 2008
- Last updated
- May 25, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 42049 | MO | Primary |
Addresses
Primary practice location
5841 Quail Meadows Dr
Poplar Bluff, MO 63901-8542
Mailing address
5841 Quail Meadows Dr
Poplar Bluff, MO 63901-8542
Phone (573) 686-7238
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42049 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653436800000",
"number": "1417122565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5841 QUAIL MEADOWS DR",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639018542",
"telephone_number": "573-686-7238",
"fax_number": "573-686-7239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5841 QUAIL MEADOWS DR",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639018542",
"telephone_number": "573-686-7238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "DAVID",
"middle_name": "CARROLL",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-29",
"last_updated": "2022-05-25",
"certification_date": "2022-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "42049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 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.