ELLIS R ODOM (NPI# 1457330219) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457330219 |
| Entity Type | Individual |
| Full Name | ELLIS R ODOM |
| Credential | RPH |
| Practice Address |
686 Lester St Poplar Bluff MO 63901-5025 |
| Mailing Address |
Po Box 220 Poplar Bluff MO 63902 |
| Practice Telephone | 5736862411 |
| Practice Fax Number | 5736868452 |
| Mailing Telephone | 5736862411 |
| Mailing Fax Number | 5736868452 |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 042673 | MO | Pharmacy Service Providers |
| Street Address |
686 LESTER ST |
| City | POPLAR BLUFF |
| State | MO |
| Zip Code | 63901-5025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598743122 | Jeffry T Till | Social Worker | 686 Lester St, Poplar Bluff, MO 63901 | 2006-01-04 |
| 1083181416 | Elizabeth Ann L'heureux | Nurse Practitioner | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2018-10-24 |
| 1871026005 | Saint Francis Medical Center | Nurse Practitioner | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2017-04-05 |
| 1356706378 | Saint Francis Medical Center | Psychologist | 686 Lester St, Poplar Bluff, MO 63901 | 2015-12-17 |
| 1063808145 | Jennie Mabrey | Hearing Instrument Specialist | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2015-04-15 |
| 1417379488 | Chris E Martin | Social Worker | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2014-01-10 |
| 1740592435 | Michael Dewayne Roach | Family Medicine | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2010-07-09 |
| 1205168374 | Stacey E Bruce | Social Worker | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2010-02-01 |
| 1659606713 | Jill M Mcgruder | Nurse Practitioner | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2009-10-07 |
| 1821240896 | Kneibert Clinic LLC | Clinic/Center | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2008-10-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1285271239 | Front Door Wellness LLC | Physical Therapist | Front Door Wellness LLC, 5835 Quail Meadows Drive, Poplar Bluff, MO 63901 | 2019-12-09 |
| 1104470368 | Andrew Akindutire | Dentist | 3101 Oak Groove Rd., Suite 6, Poplar Bluff, MO 63901 | 2019-07-26 |
| 1780195966 | Midwest Equipment Srv Systems LLC | Technician, Pathology | 2400 Lucy Lee Parkway, Suite C, Poplar Bluff, MO 63901 | 2017-10-16 |
| 1801259387 | Richard Justin Huber | Technician, Other | 3005 Warrior Ln, Poplar Bluff, MO 63901 | 2016-04-01 |
| 1699136275 | Donja Kirkland | Recreation Therapist | 1910a Greenwood Dr., Suite D, Poplar Bluff, MO 63901 | 2016-03-10 |
| 1760866867 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 3050 Tucker Road, Poplar Bluff, MO 63901 | 2015-07-17 |
| 1407246390 | Lisa Marie Payne | Physical Therapist | 4358c Highway Pp, Poplar Bluff, MO 63901 | 2015-01-29 |
| 1700202488 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1602 W. Harper Street, Poplar Bluff, MO 63901 | 2014-03-05 |
| 1932521648 | Essential Family Healthcare, LLC | Clinic/Center | 1369 North Westwood Blvd., Poplar Bluff, MO 63901 | 2014-01-15 |
| Find all providers in zip 63901 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306241393 | Rachel Garner | Pharmacist | 225 Physicians Park Ste 100, Poplar Bluff, MO 63901-3918 | 2014-11-03 |
| 1275959538 | Jodie Burnett | Pharmacist | 333 S Westwood Blvd Ste Ofc, Poplar Bluff, MO 63901-5500 | 2014-03-11 |
| 1083050868 | Sylvan Harold Cohen | Pharmacist | 449 Hwy 53 South, Poplar Bluff, MO 63901 | 2013-05-20 |
| 1093031841 | John Judson Kersbergen | Pharmacist | 2233 N Westwood Blvd, Poplar Bluff, MO 63901-2332 | 2010-04-19 |
| 1417122565 | David Carroll Odom | Pharmacist | 5841 Quail Meadows Dr, Poplar Bluff, MO 63901-8542 | 2008-04-29 |
| 1356551592 | Letassy Pharmacy | Pharmacist | 1014 W Pine St, Poplar Bluff, MO 63901-4840 | 2007-05-23 |
| 1104961515 | Gary Michael Simmons | Pharmacist | 909 W Pine St, Suite 1, Poplar Bluff, MO 63901-4958 | 2007-02-21 |
| 1215014865 | Jennifer Dennis | Pharmacist | 225 Shelly Ln, Poplar Bluff, MO 63901-7734 | 2006-11-01 |
| 1427135094 | Kenneth A Michel | Pharmacist | 2033 Schweitzer Dr, Poplar Bluff, MO 63901-2730 | 2006-11-01 |
| 1891872446 | Martin H Michel | Pharmacist | 910 N Westwood Blvd, Poplar Bluff, MO 63901-4242 | 2006-11-01 |
| Find all providers in POPLAR BLUFF | ||||
| City | POPLAR BLUFF |
| Zip Code | 63901 |
Please comment or provide details below to improve the information on ELLIS R ODOM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.