Provider Demographics
NPI:1225892482
Name:HODGEN, JESSICA DOVE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DOVE
Last Name:HODGEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NW WALNUT BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3538
Mailing Address - Country:US
Mailing Address - Phone:541-215-2411
Mailing Address - Fax:
Practice Address - Street 1:2300 NW WALNUT BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3538
Practice Address - Country:US
Practice Address - Phone:541-768-6554
Practice Address - Fax:541-768-5210
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0019575OtherPHARMACIST LICENSE