Individual
DR. ETHAN MICHAEL ODINEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
7909 HIGHWAY N, DARDENNE PRAIRIE, MO 63368-7382
(636) 561-8450
(636) 561-8450
Mailing address
7909 HIGHWAY N, DARDENNE PRAIRIE, MO 63368-7382
(636) 561-8450
(636) 561-8455
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051.304733
IL
183500000X
Pharmacist
Primary
2022011896
MO
183500000X
Pharmacist
26029005A
IN
183500000X
Pharmacist
43211
TN
Other
Enumeration date
11/22/2020
Last updated
09/12/2022
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