Provider Demographics
NPI:1639186174
Name:HODGE, ROBERT E II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HODGE
Suffix:II
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 1:320 W KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4229
Mailing Address - Country:US
Mailing Address - Phone:870-239-9535
Mailing Address - Fax:870-236-3065
Practice Address - Street 1:320 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4229
Practice Address - Country:US
Practice Address - Phone:870-239-9535
Practice Address - Fax:870-236-3065
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0917340001Medicare ID - Type Unspecified