Active NPI
Queenette Odim, RPH
- Pharmacist
- Randolph, MA
National Provider Identifier
1801665823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH996935
- Practice address
- 170 N Main St
Randolph, MA 02368-4629 - Phone
- (781) 963-7713
- NPI assigned
- Jan 2, 2024
- Sex
- Female
- Sole proprietor
- No
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 | PH996935 | MA | Primary |
Addresses
Primary practice location
170 N Main St
Randolph, MA 02368-4629
Mailing address
170 N Main St
Randolph, MA 02368-4629
Phone (781) 963-7713
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 |
|---|---|---|---|
| PH996935 | MA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Eastern Co Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704153600000",
"number": "1801665823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "170 N MAIN ST",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023684629",
"telephone_number": "781-963-7713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 N MAIN ST",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023684629",
"telephone_number": "781-963-7713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODIM",
"first_name": "QUEENETTE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-02",
"last_updated": "2024-01-02",
"certification_date": "2024-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH996935",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.