Provider Demographics
NPI:1386247245
Name:LIM, ODOM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ODOM
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WASHINGTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-3344
Mailing Address - Country:US
Mailing Address - Phone:978-458-3159
Mailing Address - Fax:
Practice Address - Street 1:240 INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3653
Practice Address - Country:US
Practice Address - Phone:978-762-4439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist