Provider Demographics
NPI:1205023991
Name:HODGES, BRIAN MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:HODGES
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 1:5300 MACCORKLE AVE SE
Mailing Address - Street 2:ROOM 1-SD38
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2222
Mailing Address - Country:US
Mailing Address - Phone:304-388-9717
Mailing Address - Fax:
Practice Address - Street 1:5300 MACCORKLE AVE SE
Practice Address - Street 2:ROOM 1-SD38
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2222
Practice Address - Country:US
Practice Address - Phone:304-388-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6002183500000X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support