Healthcare Provider Details

I. General information

NPI: 1295489573
Provider Name (Legal Business Name): BONNE CHERIE HODGES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W WALLACE ST
SAN SABA TX
76877-4433
US

IV. Provider business mailing address

2210 COUNTY ROAD 111
LAMPASAS TX
76550-9766
US

V. Phone/Fax

Practice location:
  • Phone: 325-372-3033
  • Fax:
Mailing address:
  • Phone: 956-227-5929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33035
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: