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General NPI Number Information
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NPI Number | 1780960682
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Entity Type | Individual
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Provider Name | RAE HODGE RPH
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Gender | Female
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 2102 NEZ PERCE DR
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City | LEWISTON
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State | ID
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Zip | 83501-4116
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Country | US
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Telephone | 208-743-4434
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Fax | 208-743-9422
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Provider Business Mailing Address
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Address Line | 711 VISTA AVE
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City | LEWISTON
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State | ID
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Zip | 83501-4626
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Country | US
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Telephone | 208-305-8119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P5082
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0008715
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00019210
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License Number State | WA
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