Provider Demographics
NPI:1053527952
Name:HODGES, JOAN ELLEN (RPH)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELLEN
Last Name:HODGES
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 1:428 S 6TH ST
Mailing Address - Street 2:P.O. BOX 306
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1445
Mailing Address - Country:US
Mailing Address - Phone:319-523-8454
Mailing Address - Fax:
Practice Address - Street 1:312 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1204
Practice Address - Country:US
Practice Address - Phone:319-523-3784
Practice Address - Fax:319-523-3299
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist