Healthcare Provider Details

I. General information

NPI: 1053657601
Provider Name (Legal Business Name): DONALD DEE HODGES I RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 HOTCHKISS DR
FORT COLLINS CO
80525-3469
US

IV. Provider business mailing address

1719 HOTCHKISS DR
FORT COLLINS CO
80525-3469
US

V. Phone/Fax

Practice location:
  • Phone: 970-217-6625
  • Fax:
Mailing address:
  • Phone: 970-217-6625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14000
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: