MEDICARE: ROBERT E DODGE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03213765	OH

General Provider Information

NPI Number	:	1588645642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT E DODGE RPH

Provider Business Mailing Address
First Line	:	PO BOX 38
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-0038
Country	:	US
Telephone Number	:	419-732-3151
Fax Number	:	419-734-6338

Provider Business Practice Location Address
First Line	:	200 MADISON ST
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-1143
Country	:	US
Telephone Number	:	419-732-3151
Fax Number	:	419-734-6338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	12/07/2018

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Directions to “ ROBERT E DODGE RPH” Practice Location

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