Provider Demographics
NPI:1659369866
Name:HODGES, CLINTON WADE (RPH)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:WADE
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 1:1689 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2157
Mailing Address - Country:US
Mailing Address - Phone:478-452-5166
Mailing Address - Fax:
Practice Address - Street 1:CSH PHARMACEUTICAL SERVICES
Practice Address - Street 2:LAWRENCE RD.
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31062-0001
Practice Address - Country:US
Practice Address - Phone:478-445-4043
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH008281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist