Provider Demographics
NPI:1669507281
Name:DODGE, JAMES LEVANT (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEVANT
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 1:163 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-7930
Mailing Address - Country:US
Mailing Address - Phone:989-426-2807
Mailing Address - Fax:
Practice Address - Street 1:1218 N STATE ST
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1246
Practice Address - Country:US
Practice Address - Phone:989-426-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist