Provider Demographics
NPI:1215606348
Name:HODGE, CHRISTIAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 TRUCKEE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8692
Mailing Address - Country:US
Mailing Address - Phone:856-571-5335
Mailing Address - Fax:
Practice Address - Street 1:1985 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-1325
Practice Address - Country:US
Practice Address - Phone:720-274-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0020703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist