Provider Demographics
NPI:1194844225
Name:RHODES, JAMES H (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:H
Last Name:RHODES
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 1:2705 CORRECTIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-3627
Mailing Address - Country:US
Mailing Address - Phone:712-258-0113
Mailing Address - Fax:
Practice Address - Street 1:2705 CORRECTIONVILLE RD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-3627
Practice Address - Country:US
Practice Address - Phone:712-258-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0001230Medicaid