Provider Demographics
NPI:1033498076
Name:HODSON, BRUCE A (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:HODSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 N RUPPERT RD
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:IN
Mailing Address - Zip Code:47918-8050
Mailing Address - Country:US
Mailing Address - Phone:765-762-6173
Mailing Address - Fax:
Practice Address - Street 1:3530 STATE ROAD 38 E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5121
Practice Address - Country:US
Practice Address - Phone:765-448-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014450A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist