Provider Demographics
NPI:1639216609
Name:HODGES, JASON ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:HODGES
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 1:204 GRANTS WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4477
Mailing Address - Country:US
Mailing Address - Phone:251-377-5303
Mailing Address - Fax:
Practice Address - Street 1:676 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7866
Practice Address - Country:US
Practice Address - Phone:800-486-8792
Practice Address - Fax:800-486-8078
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12448OtherAL PHARMACIST LICENSE