Provider Demographics
NPI:1063781706
Name:HODGE, KAREN V (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:V
Last Name:HODGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 E HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6050
Mailing Address - Country:US
Mailing Address - Phone:352-394-1748
Mailing Address - Fax:352-394-3565
Practice Address - Street 1:2590 E HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6050
Practice Address - Country:US
Practice Address - Phone:352-394-1748
Practice Address - Fax:352-394-3565
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist