Healthcare Provider Details

I. General information

NPI: 1235791153
Provider Name (Legal Business Name): FRANKLIN WAYNE HODGES JR. R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 SAINT FRANCES ST
LEAKSVILLE MS
39451
US

IV. Provider business mailing address

P.O. BOX 699
LEAKSVILLE MS
39451
US

V. Phone/Fax

Practice location:
  • Phone: 601-394-2602
  • Fax: 601-394-5501
Mailing address:
  • Phone: 601-394-2602
  • Fax: 601-394-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE7629
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: