Provider Demographics
NPI:1972640688
Name:HODGE, KENNETH (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:HODGE
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 1:558 DRAKESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9637
Mailing Address - Country:US
Mailing Address - Phone:973-584-1198
Mailing Address - Fax:973-543-2396
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1505
Practice Address - Country:US
Practice Address - Phone:973-543-2525
Practice Address - Fax:973-543-2396
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01373700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist