Provider Demographics
NPI:1508451774
Name:HODGE, KIM DEANNE (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:DEANNE
Last Name:HODGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-9598
Mailing Address - Country:US
Mailing Address - Phone:912-695-2555
Mailing Address - Fax:
Practice Address - Street 1:1955 E MONTGOMERY CROSS RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5036
Practice Address - Country:US
Practice Address - Phone:912-351-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist