Provider Demographics
NPI:1912594201
Name:HODGE, LISA LONG (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LONG
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 1:8308 EDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8602
Mailing Address - Country:US
Mailing Address - Phone:919-624-7333
Mailing Address - Fax:
Practice Address - Street 1:213 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3257
Practice Address - Country:US
Practice Address - Phone:919-688-1368
Practice Address - Fax:919-682-3191
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist