Provider Demographics
NPI:1528338175
Name:HODGE, BARRY STEPHEN (RPH)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:STEPHEN
Last Name:HODGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 SANDY POINT RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1636
Mailing Address - Country:US
Mailing Address - Phone:727-254-5928
Mailing Address - Fax:727-260-6190
Practice Address - Street 1:2495 SANDY POINT RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1636
Practice Address - Country:US
Practice Address - Phone:727-254-5928
Practice Address - Fax:727-260-6190
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS26828OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH