Provider Demographics
NPI:1992289086
Name:ODIKA, MCPETER (PHARMD)
Entity type:Individual
Prefix:
First Name:MCPETER
Middle Name:
Last Name:ODIKA
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 1:1401 CAVALRY LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5743
Mailing Address - Country:US
Mailing Address - Phone:281-757-7759
Mailing Address - Fax:
Practice Address - Street 1:960 E FM 2410 RD
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-7131
Practice Address - Country:US
Practice Address - Phone:254-698-6011
Practice Address - Fax:254-892-6995
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist