Provider Demographics
NPI:1568892933
Name:HODGE, JASON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HODGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 JACKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:PA
Mailing Address - Zip Code:15202-2808
Mailing Address - Country:US
Mailing Address - Phone:585-356-2306
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY DRIVE C
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240
Practice Address - Country:US
Practice Address - Phone:412-360-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist