Provider Demographics
NPI:1215953393
Name:HODGE, LAURA SMITH (RPH)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SMITH
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 1:635 ARROWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-6505
Mailing Address - Country:US
Mailing Address - Phone:828-287-7117
Mailing Address - Fax:828-287-7649
Practice Address - Street 1:635 ARROWOOD RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-6505
Practice Address - Country:US
Practice Address - Phone:828-287-7117
Practice Address - Fax:828-287-7649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13592OtherPHARMACIST LICENSE