MEDICARE: JUSTIN HODGES

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	2017026891	MO

General Provider Information

NPI Number	:	1770188336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN HODGES

Provider Business Mailing Address
First Line	:	1288 BARDOT LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-5329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11560 OLIVE BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7111
Country	:	US
Telephone Number	:	314-995-7128
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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Directions to “ JUSTIN HODGES ” Practice Location

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