Provider Demographics
NPI:1154602928
Name:SODER, REBECCA JEAN (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:SODER
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 1:7347 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1159
Mailing Address - Country:US
Mailing Address - Phone:330-342-9531
Mailing Address - Fax:
Practice Address - Street 1:9043 DARROW RD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2138
Practice Address - Country:US
Practice Address - Phone:330-405-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03222869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist