Individual
MRS. KELLY ANN ODUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
6505 N ILLINOIS ST, FAIRVIEW HEIGHTS, IL 62208-2001
(618) 394-8744
(618) 394-1026
Mailing address
6505 N ILLINOIS ST, FAIRVIEW HEIGHTS, IL 62208-2001
(618) 394-8744
(618) 394-1026
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051038139
IL
Other
Enumeration date
09/20/2011
Last updated
09/20/2011
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