Provider Demographics
NPI:1588645642
Name:DODGE, ROBERT E (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:DODGE
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-0038
Mailing Address - Country:US
Mailing Address - Phone:419-732-3151
Mailing Address - Fax:419-734-6338
Practice Address - Street 1:200 MADISON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1143
Practice Address - Country:US
Practice Address - Phone:419-732-3151
Practice Address - Fax:419-734-6338
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist