Provider Demographics
NPI:1104952282
Name:ODENS, DEBORAH JEAN (PD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:JEAN
Last Name:ODENS
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-1271
Mailing Address - Country:US
Mailing Address - Phone:605-234-5833
Mailing Address - Fax:605-473-0708
Practice Address - Street 1:601 GALL ST.
Practice Address - Street 2:
Practice Address - City:LOWER BRULE
Practice Address - State:SD
Practice Address - Zip Code:57548
Practice Address - Country:US
Practice Address - Phone:605-473-8227
Practice Address - Fax:605-473-0708
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR4362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR4362OtherPHARMACY LICENSE