Provider Demographics
NPI:1548381676
Name:KODMAN, JAMES ALBERT (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALBERT
Last Name:KODMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 STUTZMAN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3622
Mailing Address - Country:US
Mailing Address - Phone:724-388-3138
Mailing Address - Fax:
Practice Address - Street 1:20 N 7TH ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-463-4151
Practice Address - Fax:724-349-2567
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043683T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist