MEDICARE: DR. BRIAN MATTHEW HODGES PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	6002	WV
2	1835N1003X	Nutrition Support Pharmacist	6002	WV
3	1835P1200X	Pharmacotherapy Pharmacist	6002	WV

General Provider Information

NPI Number	:	1205023991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN MATTHEW HODGES PHARMD

Provider Business Mailing Address
First Line	:	5300 MACCORKLE AVE SE
Second Line	:	ROOM 1-SD38
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2222
Country	:	US
Telephone Number	:	304-388-9717
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 MACCORKLE AVE SE
Second Line	:	ROOM 1-SD38
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2222
Country	:	US
Telephone Number	:	304-388-9717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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