Provider Demographics
NPI:1134670466
Name:HODGES, CINDY (DPH)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BODIN CIR FL 2
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:707-423-7657
Mailing Address - Fax:707-423-5346
Practice Address - Street 1:461 SKYMASTER CIR
Practice Address - Street 2:BLDG 650
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1909
Practice Address - Country:US
Practice Address - Phone:707-423-7658
Practice Address - Fax:707-423-5346
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9882183500000X
TN5736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134670466OtherNPI