Provider Demographics
NPI:1285185504
Name:HODGDON, NICOLE VICTORIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:VICTORIA
Last Name:HODGDON
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 1:271 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2088
Mailing Address - Country:US
Mailing Address - Phone:203-912-2644
Mailing Address - Fax:
Practice Address - Street 1:519 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1526
Practice Address - Country:US
Practice Address - Phone:860-388-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist