Healthcare Provider Details

I. General information

NPI: 1780018192
Provider Name (Legal Business Name): KAREN ANN HODES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CALIFORNIA ST
REDLANDS CA
92374-2910
US

IV. Provider business mailing address

1301 CALIFORNIA ST
REDLANDS CA
92374-2910
US

V. Phone/Fax

Practice location:
  • Phone: 909-809-3110
  • Fax: 909-809-3101
Mailing address:
  • Phone: 909-809-3110
  • Fax: 909-809-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 29022
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number06331
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: