Provider Demographics
NPI:1760595482
Name:HODGE, TAMMY L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:HODGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17009 EAST STATE HWY 115
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:CO
Mailing Address - Zip Code:81226
Mailing Address - Country:US
Mailing Address - Phone:719-784-5308
Mailing Address - Fax:
Practice Address - Street 1:903 MOORE DR.
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226
Practice Address - Country:US
Practice Address - Phone:719-784-5308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist