Provider Demographics
NPI:1619257201
Name:HODGES, CRAIG R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:HODGES
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 1:4495 W STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2855
Mailing Address - Country:US
Mailing Address - Phone:765-586-0750
Mailing Address - Fax:
Practice Address - Street 1:4495 W STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2855
Practice Address - Country:US
Practice Address - Phone:812-342-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209680183500000X
IN26023257A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist