Individual
ELLIS R ODOM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
686 LESTER ST, POPLAR BLUFF, MO 63901-5025
(573) 686-2411
(573) 686-8452
Mailing address
PO BOX 220, POPLAR BLUFF, MO 63902
(573) 686-2411
(573) 686-8452
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
042673
MO
Other
Enumeration date
01/11/2006
Last updated
07/08/2007
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